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 Samuel,
When someone starts ARVs ideally their viral load should become undetectable within 1-3 months. However, for some people this can take longer. Though yours is 374 its still detectable. What was it when you started meds? What did your healthcare professional say about it still being detectable?
My name is Sammy my viral load is 374 is it high I started taking my meds last year September and I skip my my meds only once should I be worried or can I transmit to other person
Hi Nangamso,
Please see here: http://i-base.info/qa/3067
hi I am nangamso I would like to know if I had a viral load that is less than 40 copies in novemeber 2017 is it safe for me to do a yellow fever today 23.03.2018 if I am travelling to Nigeria ,lagos on the 27.03.2018 please reply I need to know before I go or do I have to do the check up first before I do the yellow fever vaccination.
Hi Leslie, Blips can be caused by another infection. So it’s always a good idea to have the clinic check for these as well as getting another viral load test. You can ask the doctor if your meds are still working well and discuss possible resistance. You can find more information about viral load blips and drug resistance in the guide to Changing treatment and drug resistance. You can talk to your doctor about changing treatment if necessary. Staying undetectable can protect your partner of course.
Yes I Am On Atrozia.My Viral Load Was Undetectable 1year 4 months ago and have been up and down but never more than 400.Is It Possible That I Could Infect My Partner?
Hi Leslie, Are you on HIV treatment (ART)? If you are, and you have been undetectable, then this could be a blip. You can read more about increases in viral load and blips here. What meds are you taking?
My Viral Load Is 400 Can This Be Considered As Undetectable?What Are The Risks Of Transmission?
Hi Samke, Do you mean you are changing, or transferring, treatment to LTD? I’m asking because there is a new pill that contains 3 drugs. They are L=lamivudine, T=tenofovir and D=dolutegravir. TLD is now becoming available in South Africa. Do you live there? If so you can contact the Treatment Action Campaign who know about TLD.
Hi can you please explain this to me I saw it on my transfer letter as I am relocating vl:LTD thank you