HIV Treatment Failure
How can I get sick if HIV medicine works so well?
If you don't get your viral levels to undetectable, the virus will continue to figure out a way to get around the medication. It's just like with antibiotics. If you take it halfheartedly, the bacteria will grow despite the halfhearted attempts. HIV treatment is, in many ways, similar. So, unless you snuff out the virus completely early on, resistance will develop and AIDS comes along naturally, because without HIV treatment, your HIV positive status then turns into an AIDS diagnosis and leads to a cascade of other very serious problems. It's really important for people to know early on that their first shot with HIV medicine is their very best shot.
What is a 'viral blip'?
Over time, you should maintain an undetectable viral load. It's very common to see occasionally what's called a viral blip, and that is a one-time viral load test that jumps up for a variety of reasons. Research says that one-time viral blip is not a problem. But if you have more than one viral blip, say over the course of four weeks, you have detectible viral load and you see it increasing, what that recurrent viral blip indicates is HIV treatment failure, in which case you'll need to change your medication.
Should I be worried if I have a viral blip?
A viral blip is something to pay attention to. More than one viral blip is definitely something to worry about. But one time jump up in viral load doesn't mean it's the end of the world. Most times, if you become more adherent to your medication, sometimes the viral blip will just go away naturally. But if you find yourself on two consecutive visits to your doctor where you have a detectable viral load, that's the beginnings of treatment failure, and you should definitely talk to your doctor about changing medicine.
Why would I get two or three viral blips in a row?
The reasons for having two or three viral blips would be treatment failure. That means that HIV itself has found a way to get around the medicine that you are taking, causing the viral blip. The HIV virus has adapted to this new environment. It's called resistance and it's very similar to antibiotics, for example. There are some resistant bacteria that have grown. In the same way, there's HIV that has become resistant to certain medications. If you see a rising viral load over time, that means that the virus has outsmarted the medicine and you need to change the medicine around to keep the HIV virus at bay.
Is treatment failure a sign of a serious problem?
I think that a treatment failure as defined by two or three blood tests that say you have a detectable viral load is a problem. It either says that the drug isn't right for you or that you're not taking the drug correctly. I think every time you descend from first line treatment to second line treatment to salvage therapy, your choices get more narrow and the drugs become more clumsy and more difficult to take. So what you want to do is take your best medicine early on and make it last for as long as possible. If you begin to see a rising viral load, you need to redouble your efforts to be adherent to the medicine, or you need to change the medicine entirely. There are a variety of tests doctor can order to find out exactly what is going on in your blood, what kind of mutations may have developed, and what kind of medications are best for the type of virus that you may have.
What is 'salvage therapy'?
Salvage therapy is a last-ditch attempt to control your HIV viral load. It is the end of the line for HIV treatment. That could be the case for a variety of reasons, but most likely because of your adherence, you have failed first line treatment, you've switched your medicines and attempted second line treatment, and you've gone down a fair number of different routes until you are left with the most difficult, the most clumsy, and the drug with the most side effects, but it's your last attempt to get your viral load checked. There is an injectable drug. It's very difficult to take. It will clobber the HIV, stop it dead in it's tracks, but you'll be injecting yourself with a medication once a day for the rest of your life. I think it's better to focus on your first line treatment right up front and be highly adherent to your medicine and take that convenient one pill, once-a-day for twenty years. The further you stay away from salvage therapy, the better off you're going to be in the long run.
Is it possible to be healthy again after having treatment failure?
Fifteen years ago, I had treatment failure: I had a very high viral load and very low T-cell. It was terrifying and I didn't feel healthy. I get skin rashes, and itching when a treatment fails, and I just felt not well. And it's funny because when the new medication was introduced and I took it, it was really very difficult to take at first but then all of a sudden you start to wake up and feel great. Just last week I got my T-cells, they were the highest they've ever been. They were down to a low of 18, but just last week they were 74 which is in the normal range. I haven't had a detectable viral load in 10 or 12 years. And I feel great. I'm definitely not sick. I feel really energetic, actually a little hyper. I feel good in the morning when I wake up. I enjoy my work. I enjoy my friends. I have a lot of energy. And I've learned to really appreciate life because it's so fleeting. You know I think when you are younger you don't have an appreciation for just how fleeting life really can be.