Question

Why is my viral load not undetectable?

5 November 2012. Related: All topics, CD4 and viral load.

Good morning,

I’m confused about my lab results i.e. CD4 and VL numbers!

I just got my last lab results which were taken in October, CD4 464, VL 167.

Since I started treatment almost 2 years ago I have only reached undetectable and that was way back in December 2011.

Since then both the CD4 and VL numbers kept fluctuating.

I’m not concerned about my CD4 since it never went down the 300s but on the other hand I am worried that my viral load keeps increasing.

Tests were taken every 3 months with the last test being done after 2 months and my VL results were as follows:

April 2012: 83
August 2012: 123
October 2012: 167

First and second tests were discussed with my ID doctor and he mentioned blips which I knew it could happen but 3 blips in a year, I find that very strange and not very convincing.

Also, my last lab results indicated that my CD4 increased to 464 as opposed to 310 in August. Although this is good, it is still confusing since usually as the CD4 increases the viral load decreases.

Such numbers are freaking me out!

Any words of advice would be much appreciated, please.

Thanks!

Answer

Answer: Rebecca McDowall

Hello,

Thank-you for your question. I’m sorry to hear that your test results have you worried. Although these viral load test results are still low it is important to find out what is causing this.

A ‘blip’ is defined by the British HIV Association (BHIVA) guidelines as “a detectable VL less than 400, which is preceded and followed by an undetectable result”. So these three detectable results wouldn’t be seen as ‘blips’.

The term used by BHIVA for repeatedly detectable, but low, viral loads is ‘low-level viraemia’. About 8% of people do experience this, so you’re not alone.

Your viral load is still very low, and so your chances of developing resistance are still low. But it’s important to look into what is causing this.

If your viral load remains at this low but detectable level your doctor may want to measure drug absorption levels, or talk about adherence.  Some treatment regimes (those based on protease inhibitors) are more likely to be associated with low-level viraemia. Therefore s/he may also want to talk about changing treatment.