Andria E-Mordaunt Woman of substance
I’ve got a number where there wasn’t one; a Hollywood
musical would probably say where “there oughtn’t not to be one”.
And it’s a number I haven’t seen for a long time. I don’t
feel I’ve changed in any way physically. It’s the science of HIV
that’s changed and it’s moving faster than I. My clinic in Edinburgh
has started to use a new viral load test and it has found me out for the fake
that I am. I am not superhuman, I can’t fly wearing tight underpants
over my trousers, and I can no longer keep my HIV locked away in a box.
The number I now have is of course a viral load. And it’s 56 to be precise.
There was a time in the depths of history when a viral load number wasn’t
an issue. When I first started antiretroviral therapy in December 1995 there
was no such thing as a viral load test. Drugs to treat HIV were new, and there
was just a CD4 count to measure if they worked.
Then along came viral load tests, sensitive down to less than 500, then 400,
then 50. And there the science stuck for a while. And there I stuck too. After
a few early diarrhoea-inducing therapies that failed to get my viral load
under control, I eventually settled on more or less what I am on now in 1999.
I’ve happily gone along watching my CD4 count go up, from a low point
of 32 in December 95, to its present dizzy heights of 782, with more than
seven years of having an “undetectable viral load” (ie less than
50).
I liked the fact everything was going in the right direction, and I liked
having ‘no’ viral load. It made me feel like I had my HIV under
control in a sealed ‘undetectable’ box. I felt secure. Now the
science has overtaken me and my clinic in Edinburgh has started using a more
precise test that measures down to either 40 or 20; I can’t remember
which. The exact level passed me by as, in surprise, I suddenly heard a number
used again when my viral load was talked about.
The most important thing about this test is that it is more precise and it
can find the HIV in your body if it’s there. And let’s face it;
it’s there in all of us. I may be one of the few to get caught out in
this change, and there may well be viral load tests measuring precisely down
to 10 in development that will catch out a few more.
That’s because we are all in fact on FAART: Fairly Active Antiretroviral
Therapy. The drugs we have can no more eradicate HIV from our bodies than
we can soar through the air like a speeding bullet. We all have some level
of HIV reproducing in our bodies, but how much? And how much is acceptable?
When I didn’t have a viral load this was an academic question. Now the
science has parted company with me and it isn’t.
If one test comes back at 56, then the next 42, so what? They are only numbers
aren’t they? The real me knows the numbers don’t matter. It’s
low level reproducing HIV. My body has probably been producing HIV at this
level for the past seven years. It’s just that there wasn’t a
test around at the time that could tell me that. The real me knows my HIV
drugs are working as well today as they were seven years ago, only my comfort
blanket has been removed.
In fact, I came out of the clinic feeling OK about the result. My first thought
was that at work we ought to alert other people. There is after all no point
in telling everyone that the goal of HIV therapy is an undetectable viral
load if it isn’t achieveable. Then I started to think about myself.
I know I don’t feel nervous about it. I’m not going to start running
to the clinic for a viral load test every two months. My drugs are still working.
But there is a difference between how the logical me feels, and how it has
affected the way I feel about myself. A chink opened up in my armour. For
a while I could kid myself that I could soar through the air like a speeding
bullet. No longer. Numbers speak louder than words. Especially now that I’ve
had the word “undetectable” taken away from me.
