Question

Shall I go for another viral load test?

16 July 2008. Related: All topics, CD4 and viral load.

After beginning treatment with a viral load of 25,000 copies/mL and a CD4 count of 250 cells/mm3 – I reached undetectable viral load (less than 40 copies/mL) and a CD4 count of 380 in 8 weeks.

I thought I was in the clear, but now my new test results, after switching from efavirenz to atazanavir/r (Reyataz/Norvir) due to intolerable side effects, are CD4 350 and viral load at 57.

Both numbers are OK, I guess, but the trends seems to me to be in the wrong direction.

My question is whether a drop in your CD4 count is normal after initial treatment and is a viral load of 57 copies/mL still ok? – or should I insist on new tests?

Thanks for your vital help.

Answer

Answer: Simon Collins

Changing treatment quite often leads to some worry about test results – this is very common.

CD4 counts can fluctuate quite substantially. Reasons include the time of the day when the sample is taken, whether you are under stress, whether there is any other underlying infection and many others – even a lab mistake sometimes.

Your doctor probably doesn’t see anything to worry about and would see all this results as very similar. Usually it takes several months for your CD4 count to increase after starting treatment.

Talk to your doctor about this. So long as you have no other problems, it is fine to wait until your next result before worrying any more. Nothing serious will happen before then.

As for the viral load, 57 could be a blip (a sudden unexplained small increase that goes back to undetectable on its own) or just a lab error. It is good to have a second confirmatory test now. If the result is back to normal, then it is all right and apparently the combination works well.

If the second result, however, also shows a detectable VL, then you may need to change your combination and the sooner the better. Discussion with your doctor in that case will be necessary.

There is some detailed information on these topics in the i-Base booklet on changing treatment.