Question

How often should my viral load be tested?

7 November 2009. Related: All topics, CD4 and viral load, Other tests.

I tested positive in April 2009 and I think I might have been infected around January of the same year. Through a lot of reading I have finally come to terms with my diagnosis and feel I am doing OK and getting on with my life and projects.

I do want to manage my infection properly and though I am very happy with my hospital and care there are a few details I would like to clarify.

I get tested for CD4 every 4 months which by the way was 600 the last two times. They also check for liver function etc. My question is why I do not get tested for viral load every 4 months as well? I have read that people with consisting high viral load should start treatment earlier disregarding of CD4 count.

Am I entailed to ask for a viral load test every 4 months as well? I would like to know my rights as not always is that easy to access the right care through the NHS and sometimes I feel I am asking for a big favour rather that my statutory rights as a tax payer.

Answer

Answer: Simon Collins

Thanks for your question and for being able to post the answer online.

UK guidelines for monitoring someone not yet on treatment include routine tests every 3-4 months, so the timing of your tests are fine, especially if your CD4 count is still stable and high. This usually includes a full blood count (CD4 and others), viral load and others (liver function etc).

Some clinics modify this based on studies that show that:

i) for people not on treatment with high CD4 counts and low viral load, that a viral load test once or twice a year is probably fine; and

ii) for people on stable treatment with high CD4 counts and undetectable viral load, that a CD4 counts once or twice a year is probably fine.

When not on treatment, your CD4 count is more important and when on treatment checking your viral load is undetectable is more important.

The clinics that do this should have the flexibility for you to ask for more frequent test if you want or need this, but it probably won’t add much that is useful.

If your CD4 count stats to drop significantly, then your viral load would then be routinely checked more frequently again.

You didn’t give your last viral load test but I would think it was very low.

The 3-4 monthly tests are more based on historical practice that any proven need. When people are stable, it might be ok to monitor much less frequently just as in more complicated situations they are sometimes tested every month.

If you are not happy, then speak to your doctor or health advisor about your concerns. If you are still unhappy after hearing their explanation and still want more frequent monitoring then you could change to a clinic that still monitors both test more frequently. If you call the i-Base phoneline we can provide more details.

I’m not sure that there would be any medical advantage to this though in terms of any benefit to your health.

It is good to hear that you are keeping on top of everything and that life is getting easier again as you come to terms with living with HIV.