Question

I changed treatment but why has my viral load increased?

10 January 2012. Related: All topics, Changing treatment, Resistance, Side effects.

Could please give me an advice regarding the increase in my viral load. I’ve on treatment for five years and I was using Truvada (tenofovir+FTC) and nevirapine for my first 3 years. My viral load was undectateble. Then last year I changed to Atripla and my recent blood test shows that my viral load is dectetable to 35,000. And I’m experiencing the dizzness and headache.

Answer

Answer: Li Marhaban

If your viral load is really at 35,000, then it is likely you will need to change your treatment. This is because at this level resistance is very likely to have already developed the meds in Atripla.

I’m not sure why this would have rebounded so high if nevirapine worked so well for so long. As this is unusual, it would be worth checking that your viral load is really this high before making any change. One other possibility is that it could be a lab error (a mix up with another sample during testing) – in this case, this would be shown in a second viral load test.

Changing treatment should now be to three new drugs. Changing sooner rather than later will reduce the chance of more resistance occuring, but it is still important to stay on your current treatment until your doctor makes this change.

You mentioned about your viral load results, but not your CD4 baseline and your recent CD4 count.  If we have case history information, then we can help to assess your situation a better.

What has your doctor said about these results? What is the plan for your future treatment? Your doctor should discuss about changing your current combination to a new treatment that includes a protease inhibitor (PI).

The side effects you are currently getting are likely to be related to the efavirenz in Atripla. A combination without efavirenz should not have these side effects.

See this link for more information on this.

And here are the link to efavirenz side effects.