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 Frannie,
How often someone has a viral load test will depend on where they live and if there is a need to have a viral load test done. In the UK once someone is undetectable they’ll have a viral load test, once or twice a year. When were your viral load tests done?
My last two viral loads were 123 and 117. How often should I get my viral load retested?
Hi Teboho,
Undetectable means having a viral load below 50 copies/mL. If your result is using Log numbers it means that the result is just 3 copies/mL. And so it looks like your HIV treatment is working very well.
Log numbers are used to make it easy to work with numbers when they can be very big and very small. Here’s a link to the log value table, it goes from 10 million right down to 1 copies/mL.
Hi my what does it mean when my viral load is lower than detectable and measures o.5 m
Hi Joy,
These results look good. Your HIV treatment (ART) must be working well. The aim of ART is to reduce HIV in the blood to such a tiny amount that the viral load test says undetectable. Undetectable means anything below 50 copies/mL. So 20 copies is great.
The ‘normal’ CD4 range for someone who is HIV negative is between 460 and 1600 cells. So again 1076 is great.
Please see the frequently asked questions 7 & 8 here.
My viral load is 20 n my cd4 is 1076 is there any risk
Hi Kennedy,
A viral load of 27 is excellent, it means that you’re undetectable. Your HIV is under control.
My latest vl was 27 copies, am I at risk?
Hi Lungile,
A result of less than 20 means the meds are working well. Viral loads tests tell you how much virus is in a millilitre of blood. And 20 copies of the HIV RNA is usually written 20 copies/mL. Please this this link to a similar question.
Modern tests are more accurate and can now detect virus down to 20 copies instead of the previous test which went down to 50 copies. Below 20 copies is still undetectable for U=U of course, please see this link. The latest test which is called an essay can detect HIV RNA from 20 copies right up to 10,000,000. This is given a Log scale. This scale is used because large changes can only be captured on graphs or diagrams by using a log scale. This turns large numbers of copies/mL into ‘manageable’ figures. So 1.3 Log copies/mL means 20 copies/mL and 7 Log copies means 10,000,000. This shows the range of the viral load test.
However, 20 copies/mL is undetectable.
Hi wat does it mean wen my viral load is lower than detectable n 20 rna copies/no and d linear range of this essay is 20-10.000 Rna copies/no ( 1.3-7 log copies/ ml)