Question

I have been on treatment for 4 months, why is my viral load still detectable?

11 June 2010. Related: All topics, CD4 and viral load, Complications and coinfections, Starting treatment.

Firstly thanks for your ever so useful support. Where would any of us be without it?

I understand that on first-line therapy (I am on Atripla) one’s viral load can be expected to be reduced to undetectable levels in approximately 3 months.

Despite good adherence in terms of taking my medication every day at the same time (give or take 20 minutes max.) and so far as I understand, relevant dietary requirements my viral load after 4 months remained at about 120. It has reduced immensely of course (from over 580,000) but is not below 50. My CD4 count has more than doubled (from 148 to 340).

Can the fact that I have been co-infected with syphilis (now reduced) have an impact upon the viral load reading or what can in your opinion possibly be a reason for this slower than expected reduction?

Also is it safe to remain on my current treatment and give it longer than 3 months to see if levels will reach undetectable at a later stage? The viral load has steadily fallen every month without exception and I am reluctant to give up on Atripla so quickly.

My next appointment is next week when it will be exactly 6 months from the time I started treatment.

What can I expect from my specialist or indeed what may I be able to ask for if tests still return a result at a detectable level?

I would appreciate your opinion so as to be better prepared.

Thank you once again.

Answer

Answer: Charlotte Walker

Thank you for your question.

Whilst the general rule is that once starting treatment the viral load should become undetectable after 3 months this is not the case in every situation. Your viral load was quite high when you started medication and if it has been progressively decreasing over the last 4 months without any increases then that is a good sign. You should not give up on the Atripla after only 4 months if your viral load has been steadily decreasing.

A viral load of 120 is still very low. If at your six-month appointment with your doctor you find that your viral load is still detectable, then depending on the result, you may want to consider switching treatment.

Did you have a resistance test before starting treatment? This is recommended in the UK, and sometimes picks up resistance to treatment before it is used. Your viral load need to be higher than 500 copies/mL for a resistance test to work.

Your syphilis infection is unlikely to have prevented your viral load from reaching undetectable levels. It may have increased your viral load and reduced your CD4, but your CD4 count increase on treatment is very good, so I wouldn’t worry about this now.

For more information it may help to read a similar question by following this link