Labwork : Viral Load - by Staff

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Viral Load

by Staff

—EXPERTS CALL IT: One type is “PCR,” the other “b-DNA.”
—IT TELLS YOU: How much HIV is in your blood
—TAKE IT: After suspected primary infection. Every three months, before starting meds. Immediately before you start therapy. About a month after taking your first cocktail. Every three months on therapy.
—RESULTS IN: 4–7 days

M. Lo Talks: Michelle’s viral load jumped from 1,896 to 3,642 in five months. “Around that time, I wasn’t feeling my best,” she says. But the increase was so neglible that it might even be a coincidence.

Viral load tests measure the amount of HIV in your blood. Except for the first several months of infection, when the virus and your immune system are still getting used to each other, here’s the general rule: The higher the load, the greater the risk to your immune system. Still, the relationship between viral load and CD4s is only dimly understood, and this can make treatment decisions tricky.

In 2003, Michelle had switched from her last regimen in part because of a high viral load, and that did the trick: She hovered in the four digits—an OK place for someone with her long treatment history.

MEASURE FOR MEASURE
There are two viral load tests: the more common “polymerase chain reaction” (PCR) and the “branched DNA” (b-DNA). Just as inches and centimeters both measure length, these tests come to comparable conclusions. But results of the two different tests don’t directly correlate. Make sure you get the same test each time.
What is a “normal” viral load for an HIVer not on meds? That’s hard to say because everyone has a unique “set point”—a level of virus in the blood that seems to remain constant over time. Most people now consider anything less than 100,000 virions per milliliter of blood (PCR) “not high.”

A load in the millions is not uncommon during seroconversion, when the virus has plenty of CD4 cells to target and the immune system hasn’t yet revved up to fight.

HOW LOW CAN YOU GO?
If you’re a newbie and lucky enough not to have been infected with the growing pool of drug-resistant HIV out there, your combo should bring your viral load down to “undetectable”—that is, below what the tests can read (one test detects as low as 400; the other as low as 50).

Getting down to 400 may take a month or so on a new regimen. On average it takes three to four months to reach 50, depending, of course, on how high your viral load is to start with.

ARE YOU EXPERIENCED?
Some treatment-experienced, med-resistant HIVers (like Michelle) may no longer be able to reach undetectable. But there’s a growing debate about how low a viral load needs to be to help halt disease progression. Getting below 10,000 or even 20,000 or 30,000—partial viral suppression—has helped raise the absolute CD4 cell count in many HIVers.

THE BOTTOM LINE
Look for your viral load to drop by at least a power of 100 (from 100,000 to 1,000, for instance) when starting a regimen. Dropping by less than a power of 10 (e.g., 100,000 to 10,000) is grounds for divorce—and trying a new combo.



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