Question
Is it okay "not to worry" about my viral load rebound?
7 July 2011. Related: All topics, CD4 and viral load, Changing treatment, Resistance.
I was diagnosed HIV positive in March 2008. I started on Atripla in November 2011 (with T cell 259 and viral load of 264,000).
My last blood test in June showed T cells at 359 and viral load of 13,564.
My lowest viral load was 472 in February 2011 and highest T cell was 426 for the same time period.
However, my June blood tests also showed a cd4/cd8 ratio of 0.12 and a CD4 % of 10.
Doctor says with T cells at 359, not to worry and the increase in the viral load was probably a ‘blip’ but he will continue to monitor.
Would you agree with this “not to worry” diagnosis?
Answer
Hi
Thanks for your question and for allowing us to post this online. In this case, based on the limited information about your situation, I wouldn’t agree with your doctor.
On the one hand, your CD4 results are all good so there is little risk of any HIV-related illnesses.
However, once you are on treatment it is your viral load results that are more important.
How have you been with adherence? If you have been missing doses then your doctor needs to know this and you might be lucky and going back to strict adherence might be enough to bring your viral load back down again.
However, if your adherence has been good then the increase from 472 to 13,000 is not likely to be a blip.
In the UK, this result should have prompted the doctor to take another blood sample on the day you got these results. This sample would retest your viral load and also test for drug resistance.
Although the three drugs in Atripla (efavirenz, FTC and tenofovir) are good when the combination is working, if viral load rebounds and you stay on treatment, resistance can easily develop.
The resistance test would confirm this, and switching treatment quickly if this is the case, would reduce the chance of further resistance developing to the other drugs in your combination.
In this case, I would speak to your doctor and use this Q&A if it helps. Based on the outline of your results, the information your doctor has given you is not in line with recommendations in UK and US treatment guidelines. I would also do this when you read this and not just wait for your next routine appointment.
For more information about viral load rebounds and drug resistance see the Guide to Changing Treatment.
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