Question
Viral load undetectable then rebounded…
12 March 2006. Related: All topics, CD4 and viral load, Changing treatment, Resistance.
My viral load was undetectable but it then rebounded – could I be infected with a resistant virus?
Answer
This is a reason why treatment fails in some people.
If you were infected with a resistant virus several years ago, this may not now be detected in a resistance test. When you started treatment with one of the drugs you were resistant to, it is unlikely to work. You would therefore only be receiving two active drugs, rather than three. In working out whether it is likely that you were infected with resistant virus, consider the following points:
1. How long have you been HIV-positive?
The longer ago that you were infected, the less chance you were infected with resistant virus. This is because less people were on treatment ten, or even five years ago. If you were infected very recently, this chance is higher, as more people are using treatment now, and more people have developed resistance to at least one of the drugs.
2. Were you infected in a country where very few people were on treatment?
The risk of being infected with resistant virus is high in countries that have had access to treatment for a long time, and low in countries where fewer people have access to treatment. In the UK 10-20% of all new HIV diagnosis, are with a virus that has resistance to at least one HIV drug. This is likely to be much lower in every African country now, though as more people use treatment, the figures are likely to rise, as in the UK.
UK guidelines published in 2005, state that everyone should have a resistance test before they start treatment for the first time. They also say that everyone who is newly diagnosed should have a resistance test.
Many people still do not get this test. If in doubt, ask your clinic. If you ask you are more likely to get the test than if you don’t ask!
(Adapted from a question from the i-Base Q&A pages of the African Eye a new treatment publication for African communities affected by HIV who are living in the UK)
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