Question
Should I be freaking with a viral load of 110 after 6 months?
29 July 2011. Related: All topics, CD4 and viral load, Changing treatment, Newly diagnosed, Starting treatment.
I found out i was HIV possitive back in January. I have been taking Atripla for about 6 months. My first viral load was 480,000 and CD4 110, the second test was viral load 94 and CD4 340.
My last test showed a viral load of 110 and CD4 of 500. Why did my viral load increase? my doctor is thinking of taking off Atripla due to a fear of resistance. Is this kind of reaction common or is there cause for concern? im totally freaked out and not sure what is going on. Please give me any advice you can.
Thanks James
Answer
I’m sorry to hear about your diagnosis – it is always rough, but I hope it is getting easier as you learn more about what is involved.
It sounds like you had either been HIV-positive for several years or were recently infected and reacted more badly to this.
Most importantly, your response to treatment has been really good. CD4 response has got you back to ‘normal’ levels which is pretty remarkable in six months. Your viral load is almost undetectable and although one is a higher number the result would be interpreted as the same as the tests are really not that sensitive for 94 and 110 to be thought of as different.
Some recent research is important for the things you are worrying about now though. In the past the importance or getting viral load to undetectable levels has been based on using tests that are sensitive to 50 copies/mL. However, some viral load tests were recently shown to not be very accurate at very low levels. This meant that people getting counts that were detectable above 50 but still lower than 200 would actually still be classed as being undetectable to less than 50.
This is confusing to hear, but the research was important enough to be included in the January 2011 update of the US treatment guidelines (see the second paragraph at this link).
Without knowing where you are being treated and the test they are using it could still be too early to change treatment if everything is otherwise going well – ie if you are not getting side effects. One of the side effects from efavirenz (one of the meds in Atripla) is mood swings and anxiety, and so this is important to ask as you also sound very upset. If you think you are more sensitive to things now than before starting treatment, this might be a side effect to speak to your doctor about.
Your doctor may be a resistance expert, or may feel strongly about getting under 50, but you could take this information to your next consultation if it would help. I’ve heard this discussed in many settings and the need to get under 50 does appear to have been generally relaxed to mean under 200 now.
It really is ok to not be so anxious over this and hopefully your doctor will be able to make you feel better over this.
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