Question

Partner’s viral load has increased from 41 to 50

22 October 2013. Related: CD4 and viral load.

Hi there wonder if you can please help.

We have found your site so informative and usefull.

My partner (46 year old female) has been on Atripla for two years and has done really well on them with a very healthy CD4 counts over the year of 500 to 550 and percentages averaging 30%.

Recently after a check up there was protein in urine which the doctor was concerned about and he repeated the test, the repeat test showed protien again so he decided to change to Sustiva and Kivexa. Also after having an undetectable viral load for two years result came back as 41 detectable. He re tested bloods and viral load came back as 50. The doctor now would like to change medication again.

After reading much information on the internet etc it gives the impression that class of medication/treatment failure is when viral load is over 200.

Would it be better to change to new class or have another test to see if in fact it is a \'blip\'?

Would be really grateful for a second opinion.

Many Thanks

Answer

Answer: Rebecca McDowall

Hello,

Thanks for your question.

The term ‘undetectable’ is usually used to refer to a viral load result of 50 or lower. Although there are tests available that can measure below this level the cut off of 50 is used for establishing how well treatment is working.

Under the UK guidelines your partner’s viral load would be considered to be undetectable with both of these results- and therefore not a reason to switch treatment. These results would not be classified as a ‘blip’.

The British HIV Association guidelines recommend re-testing any viral load result that has increased above 50. A test result between 50 – 400, which is undetectable on the re-test is not treated as a matter of concern. If the re-test shows that the viral load remains above 50, or increases, or if it is above 400 this requires further investigation because this could be a sign of developing resistance.

I am not sure why your partner’s doctor would want to recommend a change of treatment while the viral load is 50. Viral load testing is not very accurate and two test results of 41 and 50 would generally be viewed as being the same. These test results do not, therefore, indicate a viral load increase.

Can I ask which clinic your partner is being seen at?

It is a good idea to discuss this with the doctor again and ask him to explain this to you. If you are not happy with his explanation it might be useful to request a second opinion from another HIV specialist.