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 K,
These results look very good. Your viral load is undetectable and your CD4 count is strong. So your HIV tretment (ART) looks like it’s working well.
The benefits of ART are not just to your own health. Treating your HIV will reduce the risk of your baby becoming HIV positive to almost zero.
So planning to conceive sounds like a great idea. You can talk to your doctor about it.
And there’s lots of info in the guide to HIV pregnancy and women’s health.
Hi, my viral load is less than 20 and my CD4 is 802 presently. Can I start planning to conceive?
Hi Monde,
Congratulations on the news that you’re going to have a baby. But I’m sorry to hear of your diagnosis.
However, it’s great that you started HIV treatment (ART) immediately. Being on ART and getting your viral load (VL) down as quickly as possible is the best way to help protect your baby from HIV.
So you are doing all you can. Do you have access to your VL results? The aim of ART is to get your VL down by the time your baby is born.
Please see this guide to HIV, pregnancy and women’s health.
The guide says that late diagnosis is defined as after 28 weeks of pregnancy but before labour starts. But if this happens to you, there is plenty that can be done to help you have a negative baby.
Please talk to the clinic about your treatment and VL results.
I was already 4months pregnant when I was diagnosed with hiv. Is my baby in danger? I started treatment immediately after being told. I’m now 5months pregnant
Hi Nelly,
We are not doctors at i-Base, sorry.
But lower than detectable can mean having a viral load lower than 50 copies/mL. This figure is usually used as a measure for undetectable. Please see this similar Q&A about what does undetectable viral load mean.
Some viral load tests are now very sensitive. They can give results of 30 copies/mL, or even not detected.
Hi Dr,what is the meaning of lower than detectable?
Hi Lisa,
How long is it until you are due to give birth? Info about pregnancy can be found here: http://i-base.info/guides/pregnancy
My viral load is 109 can hiv pass through the unborn baby am scared
Hi LaToya,
Undetectable in the UK is when your viral load is less than 50. In the US its 200. If your viral load is 400 this means that you’re still detectable.
Good day
What does it mean when viral load is less than 400.does it mean its undetectable?