Lab results are useless without informed interpretation. POZ pits old theories against the latest thinking. Guess who wins?
OLD SCHOOL: When viral load goes up, CD4s go down. NEW SCHOOL:
This ain’t no seesaw. Yes, a high viral load (say, 100,000 copies)
drives down your overworked CD4 cells, and dipping below 200 CD4s still
puts HIVers at greater risk for scary infections. But hold on: We now
know that some people sustain their CD4 counts even with detectable
viral loads (say, 10,000 copies). In many cases, this surprising
finding may reflect the effects of the HIV meds themselves: Certain
mutations that reduce the strength of certain meds also weaken the
virus. Does this mean viral load and CD4 counts are useless? Not at
all; they’re just part of a bigger picture that includes tests for
resistance and viral fitness. And remember: The trend over time is more
important than a single reading.
OLD SCHOOL: Viral blips = bad news. NEW SCHOOL: Blips don’t equal blues. Everybody
these days has their eyes on the prize: being undetectable. But what
about a “viral blip”—when no-show HIV suddenly makes a reappearance on
one test and then vanishes by the next? Although we now know that HAART
can never completely rid your body of the virus, by the same token a
blip—or even a sustained “breakthrough”—doesn’t spell doom for your
current combo. If a blip gives you the jitters, analyze your adherence
with Doc—there’s always room for improvement.
OLD SCHOOL: Drug resistance = treatment failure = oh, nooooo! NEW SCHOOL: What, me worry? Experts
increasingly support the idea that just enough virus of just the right
type may actually be a good thing—at least if the virus has mutated and
become less “fit.” Top AIDS immunologist Mike McCune, MD, PhD, at
UCSF’s Gladstone Institute, found that HIVers on “failed” regimens—with
viral loads that had rebounded to between 1,000 and 10,000 copies—had
higher-than-expected numbers of CD4 cells, meaning that their immune
systems were making a comeback! McCune’s take-home: “Although it is
preferable to have no virus at all, a detectable virus may not always
be bad.”
OLD SCHOOL: “One-size-fits-all” treatment guidelines. NEW SCHOOL: Guidelines need adjusting to fit you to a T. Just
because the guidelines are “official” doesn’t mean they’re set in
stone. In fact, in 2003 they were revised to reflect not only new
drugs on the market but new knowledge—the longer we use HIV meds, the
more we learn about them. Women with HIV often have significantly lower
viral loads than male HIVers. And although both sexes progress to AIDS
at the same rate, ladies may do so with less virus. “It’s especially
important for women to follow their CD4 cell count. If it has fallen,
it may be time to initiate treatment, even if the viral load is still
low,” says Kathleen Squires, MD, an HIV expert at the University of
Southern California. Recent studies also found that African-American
HIVers had lower viral loads than white HIVers.
OLD SCHOOL: It’s not all about numbers. Viral
load and CD4 cell count are best used to help guide decisions about
when to start, stop and switch HIV meds. But other aspects of your life
also figure, from genetic makeup and family medical history to mental
health and readiness to stick to a pill schedule. NEW SCHOOL: Some things never change. —Emily Bass
