Important note: Information in this article was accurate in 2005. The state of the art may have changed since the publication date. My partner was diagnosed HIV positive about 2 years ago with CD4 of 215 and VL 15,000. He started out on Trizivir and Sustiva and immediately became undetectable.
Earlier this year he switched from Trizivir/Sustiva to Trizivir/Viramune due to CNS side effects from the Sustiva. His CD4's have always been in the 300-350 range and never above. During his most recent visit (yesterday) we received startling news, his CD4 count was 515 but his VL now 34,000 copies. Again, please keep in mind that he had CD4 350 and VL undetectable only three months ago (his last doctor's visit).
He has 100% compliance in taking his meds, eats healthy and works out every day.
The doctor ordered another blood test yesterday and should have results back in 2 weeks.
What are chances this is a lab error? My partner mentioned that when the "new" doctor initially attempted to locate his file, she couldn't even find it! ... perhaps another patient's file (??)
If not an error, given that my partner takes his meds faithfully (1 Trizivir /1 Viramune 9am and 1 Trizivir/1 Viramune 9pm), what could possibly cause such resistance in a short period of time where the CD4 goes up dramatically along with a very sizable VL increase (i.e. undetectable to 34,000 copies)? I thought as the VL goes up the CD4 drops respectively (i.e. inverse relationship). I also thought if one were developing resistance it would more than likely start out as blips (<50 to perhaps 1000 copies) and not an explosion of 34,000 copies.
Lastly, if by chance the results were correct, what other class of meds would you suggest if this was not an error (I'm assuming a genotype would be done)?
Sorry for so many questions. This just really threw us for a loop since everything was smooth sailing up to this point.
Whenever a lab result comes in that's not what you expect, the best response is to repeat. The result of an increase in CD4 count from 300, with a significant increase in viral load is unusual.
I can't tell you what the exact odds are though that this is a lab error, though it does sound like a possibility. A change from Sustiva to Viramune should not be significant, as they have essentially identical resistance profiles.
Even with 100% compliance, it is not impossible that the virus that your partner was infected with had "built in" previously acquired resistance to one or more of the agents he is taking.
For now, wait and see what the results of the new test are. It could come back more as expected. If not, before selecting new medications, a geneotype will be very helpful. Fortunately, there are entire other classes of medications to use.
Good luck!
My partner went in today to pick up his refill of Trizivir and Viramune. Believe it or not, we STILL have not received his lab results back from two weeks ago (remember, his last results showed VL went from 0 to 34,000 and CD4 from 350 to 515).
My question is, if by chance his labs come back and it shows he's again detectable, should he immediately stop taking his meds? I understand he would then have to undergo a genotypic amd phenotypic resistance test but what should he do in the meantime (assuming it takes a while to get those results back) and is it possible to have incurred additional damage from these past two weeks?
I'm pretty confident the last results were probably an error or could have been someone else's but as in everyday life...anything is possible and we want to be prepared just in case.
I remember your case well. Viral loads and CD4 counts are collected and sent to regional labs, and it does take a while. A few years ago, phenotypes had to go to Belgium!
There are different opinions on what to do in this situation. I would not necessarily stop drugs immediately, but would discuss this with your doctor if the labs come back with a high viral load. I would move promptly to adjust the medications though. In other words, you don't have to make changes RIGHT NOW, but I wouldn't wait a few months, either.
You're doing the right thing by staying on top of the situation, but you only have to act quickly, not immediately.
Good luck.
051010
ASKD051007
AEGiS is a 501(c)3, not-for-profit, tax-exempt, educational corporation. AEGiS is made possible through unrestricted grants from Boehringer Ingelheim, Elton John AIDS Foundation, John M. Lloyd Foundation, Roche and Trimeris, the National Library of Medicine, Bridgestone/Firestone Charitable Trust, Bristol-Myers Squibb Company, and donations from users like you. Always watch for outdated information. This material is designed to support, not replace, the relationship that exists between you and your doctor.
AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.
Copyright ©1980, 2005. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content.