Question
What does a low but detectable viral load mean?
22 August 2012. Related: All topics, CD4 and viral load, Resistance.
Way back in April 2011, I started HIV treatment.
At that time my CD4 count was 250 and my viral load was 29, 000. My ID doctor prescribed Combivir (AZT/3TC) and Sustiva (efavirenz).
In December my lab results were CD4 423 and my VL was undetectable.
Further results were carried out in March and in July 2012 however these results got me worried.
My lab results for March indicated that my CD4 dropped from 423 to 380 and my viral load has increased from less than 20 to 87.
On enquiring with my ID doctor he informed me that such a increase in the viral load could probably be a blip and he wanted to see the trend of another 2 lab results.
Today I have called for my results and found out that the viral load for the test carried out in July 2012 increased once again from 87 to 123 – CD4 count not yet established.
Even though they’re saying that such an increase is of insignificant value, I am still being very concerned about these results. Could it be that the treatment is failing?
Looking forward for your answers, please.
Answer
Hello,
Thank-you for your email.
The British HIV Association treatment guidelines define virological failure (treatment failure) as two consecutive viral load results of more than 400 after a previously undetectable viral load. This is the point at which treatment change is indicated.
Low levels of detectable virus (where the viral load is more than 50 and less than 400) occurs in up to 8% of people on treatment. Often this can be reversed through improved adherence or alteration of doses. Generally this is not considered treatment failure and not a reason to recommend changing treatment.
If your viral load is rebounding due to resistance you would expect to see a significant rise in your next viral load test. If your viral load remains at this low but detectable level your doctor may want to measure drug absorption levels, or talk about adherence.
Hi Portia,
Having an undetectable viral load is excellent. It means that you’re in control of your HIV. It also means that you can’t transmit the virus when having sex without a condom.
For more info, please see here:
http://i-base.info/qa/6570
Hi, my viral load is lower than detectable limit. What does it mean?
Hi Oscar,
Its up to you when you take your meds. You need to do what works best for you. Just try and make sure that you take them at 24hr intervals, that is if they are daily, or every 12 hours if you have meds that need to be taken twice daily.
Am in HIV treatment now, I want to know if I want to change my time to drinking my pills,is it problem or what
Hi Brian,
The advice that you are getting from other HIV organisations is correct. This is because the World Health Organisations recommendations are that everyone who is HIV positive should be on medication. This includes people like you who have a high CD4 count. These recommendations are supported by excellent scientific data, of which one study is called the START study. For more information about this study please see here:
http://i-base.info/i-base-qa-on-the-start-study-results/
Therefore, if you would like to start treatment then this is something that you should discuss with your doctor. If they are not willing to start you on treatment, then please see another doctor.
Not only will being on treatment help your HIV, being on treatment means that once your viral load becomes undetectable the risk of transmission is close to zero. Please see the results of the PARTNER study for more info:
http://i-base.info/qa-on-the-partner-study/
I AM HIV POSITIVE, AND DETECTABLE. VIRAL LOAD IS CURRENTLY 5500. TWO YEARS AGO I WAS AT 18000, LAST NOVEMBER IT WAS 2200 AND NOW BACK UP TO 5500. MY T-CELLS ARE 800. SHOULD I BE ON MEDICATION, I HAVE NEVER BEEN PLACED ON MEDS, MY DOCTOR SAYS I DO NOT NEED TO BE ON MEDS AND HIV ORGANIZATIONS ARE ADVISING ME TO GO ON MEDS. AS SOON AS POSSIBLE.
Hi Innocent,
Having an undetectable viral load is brilliant. It means that the meds are working, and working really well. This is something to be happy about.
My viral load is lower than detectable, should I be worried ?
Hi Liziwe,
There’s an explanation here as to what it means to be undetectable:
http://i-base.info/qa/315
http://i-base.info/qa/6570
Being undetectable also means that the risk of you transmitting HIV to someone is close to zero. Please see the results of the PARTNER study for more info:
http://i-base.info/qa-on-the-partner-study/
Hi, please help, my viral load is lower than detectable what does this mean?