Higher HIV Blood Level Isn't Always Bad News

Temporary increases in HIV blood levels, called blips, are nothing to worry about.

The “blips” experienced by HIV patients undergoing HIV treatment are random and don’t signal drug resistance, according to a study in the latest Journal of the American Medical Association.

HIV treatment consists of a combination of several drugs. The medicines don’t get rid of HIV. Instead, they slow down the rate at which HIV makes copies of itself, suppressing the virus.

“Blips” sound innocent, but they can rattle a patient’s confidence. They occur when the virus briefly pops back up to detectable levels despite treatment. Understandably, blips can be nerve-wracking for patients until retesting shows that the blip is over.

Many patients experience blips, according to researcher Robert Siliciano, MD, PhD. Besides prompting patients’ fears and expensive tests, blips can also trigger broader worries that the virus is becoming resistant to HIV treatment. Siliciano works with Johns Hopkins University’s medical school.

Newer HIV treatment combinations have made a huge difference -- helping people live longer, healthier lives. A study in The Lancet’s October 2003 edition showed that nine out of 10 HIV-infected people on HIV treatment can expect to survive more than 10 years, regardless of their age.

Checking for Drug Resistance

Siliciano’s team took a hard look at blips. First and foremost, they wanted to find out if drug resistance was at work.

Their study was small, with 10 patients aged 39 to 59 years. Seven participants were men; three were women. All the patients had undetectable levels of HIV in their blood at the start of the study and had been on stable HIV treatment for at least six months.

Participants’ blood was scrutinized far more than normal. For three to four months, they gave blood for the study every two to three days. The intense schedule was designed to flag any rise in HIV blood levels.

During the study, nine of the 10 patients had a blip. On average, patients experienced two blips during the study. Most blips were brief, lasting an average of 2.5 days. Only one person had a blip lasting for more than one consecutive visit.

The blips were also mild, not ranging very far beyond detectable levels. Patients’ sex, age, or race did not matter. Blips were marginally associated with patients’ self-reported slipups in taking their medication.

Importantly, the researchers saw no signs of drug resistance. Instead, they say the blips seemed random.

The findings need confirmation in a larger study, preferably with patients who started HIV treatment earlier in the course of their infection than the study’s participants, say the researchers.

It’s vital to stick to the prescribed HIV treatment schedule. Research shows that people who are near perfect in taking their medication are much less likely to have HIV treatment failures.

A recent study in The Journal of Infectious Diseases showed that people who took their medications as directed 95 percent or more of the time had a much lower risk of developing drug resistance. These people were also more likely to have very low blood levels of HIV.

By Miranda Hitti, reviewed by Michael W. Smith, MD

SOURCES: Nettles, R. Journal of the American Medical Association, Feb. 16, 2005; vol 293: pp 817-829. WebMD Medical Reference from Healthwise: “Highly Active Antiretroviral Therapy (HAART).” WebMD Medical Reference from Healthwise: “Human Immunodeficiency Virus (HIV) Infection.” WebMD Medical News: “HAART Adds Years for People with HIV.” WebMD Medical News: “Be Persistent, Consistent With AIDS Medication.” WebMD Medical News: “Imperfect HIV Drug Use Raises Resistance Risk.” News release, Journal of the American Medical Association/Archives.