Questions and Answers with NAM Edwin J Bernard, editor, AIDS Treatments Update
I’ve been undetectable on my current HIV drugs for ages, but my last viral load test said I wasn’t undetectable any more; it was something like 150 copies. How worried should I be?
Once your viral load has been suppressed below 50 copies per millilitre of blood
(copies/ml) - the level at which it becomes ‘undetectable’ - it can
sometimes rise above 50 without indicating that treatment is failing. A one-off
result above 50 is called a ‘viral blip’ and they usually don’t
mean your current treatment isn’t working anymore.
My doctor said I had to take the test again and they took more blood from
me. That worried me, too.
It makes sense to find out whether this is really a blip, so testing your blood
again straight away is a good idea. If this test finds that you are ‘undetectable’ again, then it was a blip, and there is absolutely nothing to be concerned about.
However, if this test finds your viral load has risen again, then it might be
a sign your treatment is not working as well as before and you might have to change
them. The problem with blips is that you don’t know they are blips until
you get your next viral load test result.
My doctor asked if I had been taking my pills on time, and if I’d
missed any doses. I did take some doses late, and even missed one once. I’m
worried that it’s my fault and I am failing.
First of all, you don’t fail, the drugs do. Secondly, several studies have
shown that even when several blips occur over a period of months or years, people
who experience them are not at increased risk of treatment failure compared to
people who maintain an ‘undetectable’ viral load. One study author
wrote: “We found no evidence that adherence lapses or variance in dose timing
are associated with blips.” Mind you, other studies have found a link between
viral load blips and treatment failure. However, these blips tend to be higher
than the 150 copies/ml that you mention: usually two measurements of 200 or more
is something to be concerned about.
So it doesn’t necessarily mean that I’ve become resistant to my current
combination?
Again, you don’t become resistant, the HIV does. Also, if this is just a
blip, then scientists have found that there is no relationship between blips and
the emergence of resistance.
I had a bit of a cold when I took the test, and a friend said that might
have caused my viral load to go up.
There is no link between viral load blips and having a cold. In fact, a new study
found that there was even no link between having a flu jab and viral load blips;
something that had been a concern. If you are unwell, your CD4 count (also known
as T-cell count) might go down a bit, but it won’t cause a blip. However,
a big viral load rise can make you feel unwell.
So what causes these blips?
Funnily enough, most of them are due to the fact that the lab technicians doing
the tests have some technical problems counting the amount of virus when there
is so little of it. It’s not called ‘undetectable’ for nothing.
Sometimes, when they compute the amount of virus, they get it wrong. Officially,
this is known as a “statistical fluctuation” in the viral load test.
That’s not very reassuring?
Well, it’s not always the lab technicians’ fault. HIV replicates billions
of times a day, and drug levels change throughout the day as well, even when we
take our pills on time. Most people on treatment get a viral load test once every
three months, and it’s like taking a ‘snapshot’ that captures
just one moment in time. Sometimes, there is a tiny bit more virus than at other
times, but not enough to make any difference to your health or to the effectiveness
of the meds. The best way to approach a small rise in viral load is to not worry
too much, get your blood taken again, and to see your doctor as soon as possible
to discuss the results.
• NAM provides information to help you think about your use of HIV treatments,
but this is not intended to replace discussion with your doctor.
Visit NAM at www.aidsmap.com
