less than 400 copies per cc
(regular viral load test)

or

less than 20-50 copies per cc (ultrasensitive test)

A genotype test looks at the RNA molecules or genes of the virus to determine if the virus has mutated and exactly what mutations the virus' RNA has developed to resist the effects of HIV medications.  Once the mutations have been found, your healthcare provider can look up what the mutations mean in a well established table or database.

The phenotype is a complicated test where the virus is grown with the HIV medications.  Note is made of which medications inhibit the virus' growth and which medications do not work in the this way.

If they are too high, that is usually a signal that your body may be fighting an infection or some other problem.  Sometimes white cells are too high when the body's production of white cells goes out of control like in leukemia which is a cancer of white blood cells.  Certain medications can also raise white blood cells (see below)

If your white cells are too low, you can be abnormally sensitive to bacterial or fungal infections like strept or staph (bacteria) or yeast (fungus).  Many things can lower white blood cell counts such as HIV itself or drugs (zidovudine, ganciclovir, valganciclovir, sulfamethoxazole/trimethoprim, dapsone, vancomycin, amphotericin B, other sulfa drugs, pyrimethamine, chemotherapy, or interferon) or even cirrhosis of the liver and other medical problems (lupus).

White cells can be stimulated by administration of stimulating hormones like granulocyte-colony stimulating factor (G-CSF, Neupogen), granulocyte macrophage-colony stimulating factor (GM-CSF) or Neulasta.

If you have fever and your white blood cells are low, you should inform your healthcare provider promptly or go to an Emergency Department.

Anemia can be caused by many things including bleeding, low amounts of iron in the body, low amounts of vitamins, medications (zidovudine, amphotericin B, ribavirin,) general illness, HIV itself, infections, ulcers in the stomach, cancer, and other causes as well.

Anemia can be treated with many things depending on the cause:  iron supplements, erythropoietin injections, vitamin B12 supplements, folic acid supplements, transfusions (as a last resort or if you feel very bad), changing medications, treating HIV or other infections, treatments for ulcers or cancer treatment.

If you have too many red blood cells, you may feel fatigued and rarely you could have strokes or other problems from the blood being too thick.  Cigarette smoking is probably the most common cause of too many red blood cells.  Anabolic steroids, testosterone, and erythropoietin can cause too many red blood cells.   Rarely forms of bone marrow cancer can also cause this condition.

If your MCV is too low, your red blood cells are too small.  You may have iron deficiency or some genetic diseases of red blood cells.

If your MCV is too high, your red blood cells are too large.  You may have vitamin B12 deficiency, folic acid deficiency, or you may be taking certain medications such as zidovudine, stavudine, or abacavir.  Too much alcohol use (wine coolers, wine, beer, mixed drinks or liquor) can also cause your red blood cells to be too large.

Treatment of abnormal red blood cell size relates to the specific cause.  If the problem is just due to a medication, in many cases the medication may be continued, and your condition monitored.

Platelets can be lowered by HIV itself, other infections, medications (dapsone, sulfamethoxazole/trimethoprim, other sulfa drugs, pyrimethamine, amphotericin B, interferon, cancer chemotherapy, valganciclovir, ganciclovir and many others), cirrhosis of the liver, and certain forms of cancer.  Usually low platelets are not much of a problem unless you are bleeding, taking medications to thin your blood (heparin, Lovenox, or warfarin/Coumadin) or they get below 20,000 or so.  If they are low, you should avoid taking aspirin, anti-inflammatory drugs (ibuprofen, naprosyn, Vioxx, Celebrex, etc.) and you should studiously avoid injuring yourself with cuts or bruises.  Use an electric razor if possible.  If you are see bleeding (especially nose bleeds, red blood from your rectum, or black colored bowel movements) and you have low platelet cells, you should notify your Healthcare Provider immediately or go to an Emergency Department.

Platelets can be too high also.  Usually platelets that are too high are due to some sort of inflammation/infection or blood loss.  High platelets usually do not require treatment.

Treatments for low platelets depends on the cause.  In many cases if the platelets are in the range of 40,000 or above, no treatment may be necessary as long as the platelet count is not getting worse.  If low platelets are due to HIV, treating HIV with medications will slowly raise your platelets.  If low platelets are due a drug, the drug can be changed in some cases.  Platelets can also be transfused if you are bleeding.  Sometimes it might be necessary to have surgery for removal of your spleen which is an organ in your belly just above your stomach on the left side.

Sodium can be too low due to general illness, hormone problems, taking certain medications (diuretics like hydrochlorothiazide/HCTZ or furosemide/Lasix), nausea and vomiting, diarrhea or getting too much fluid that has no salt in it.  Very low sodium or sodium that drops very quickly can cause weakness and seizures (convulsions).  The approach to low sodium is to determine whether you are dehydrated or have too much fluid in your body and then treat whatever that is either by taking fluids with sodium or by removing fluid from your body.  Sodium tablets should not be used except in rare circumstances and only as advised by your healthcare provider.

Sodium can be too high usually due to dehydration.  The treatment is usually to take fluids.

If your potassium is too low, you can feel weak or your heart can go out of rhythm.  Rarely low potassium can cause generalized weakness. 

Usually low potassium is due to use of fluid pills (diuretics like furosemide/Lasix or HCTZ,) amphotericin B, or from vomiting or diarrhea.  Sometimes low potassium can be due to low amounts of acid in the body.  Normally it is not necessary to take a potassium supplement or pill, but if your potassium is low, you should eat and drink things that are high in potassium like fruits, vegetables, juices or you may be prescribed potassium supplements like pills, liquids or fizzy tablets.  Potassium supplements can upset your stomach or they can cause nausea and vomiting due to their bad taste or due to irritation of your stomach.

If your potassium is too high, you may develop heart rhythm problems.  Usually high potassium is due to weak kidneys, certain medications (spironolactone, captopril, benazepril, lisinopril, ramipril or other blood pressure medications called ACE inhibitors or ACE blockers,) excessive supplementation/intake, or hormone problems.  Treatment for high potassium may involve any combination of the following:  stopping supplementation, fluid pills (like furosemide/Lasix), increasing fluid intake, or Kayexelate which is a resin that one takes by mouth or by enema to pull the potassium out of your system.

If the creatinine is too high, your kidneys are weak or you are dehydrated or both.   Weak kidneys can be due to dehydration, a weak heart, blockage of the kidneys by stones or a big prostate gland, certain medications (like aspirin, ibuprofen, naprosyn, Vioxx, Celebrex, furosemide, sulfa drugs, certain blood pressure medications and others,) HIV itself, other kidney diseases, high blood pressure, certain infections, or autoimmune diseases (lupus, polyarteritis nodosa).

If the creatinine is too low, sometimes that might mean that you do not have a lot of muscles.

If your creatinine is too high, you should avoid aspirin, other anti-inflammatory medications (like ibuprofen, naprosyn, Vioxx, Celebrex, etc.,) and you should drink plenty of fluids.  The exception to drinking a lot of fluids is if you are on dialysis.  In that situation, consult your healthcare provider about exactly how much fluid to drink.

See what to do about high creatinine above.

Treatment of low albumin depends on the cause.

If your albumin is low due to poor nutrition, you can eat more protein-type foods like meat, fish, and beans.  You can also take nutrition supplements which are available canned (Ensure, Boost, Jevity, etc.) or in powder form (Instant Breakfast, Ensure, generic, or even whey/soy protein powder).

If your albumin is low due to poor production by the liver, you can take stress off of your liver by not drinking alcohol, by not taking acetaminophen (like Tylenol), or by changing your other medications under the supervision of your healthcare provider.

If your albumin is low due to kidney problems and losing it in the urine, you can take certain medications like lisinopril, benazepril or other ACE inhibitors or ACE blockers.

1.  muscle damage from lifting weights, running long distances, other vigorous exercise, heart damage ("heart attack")
2.  red blood cell breakup due to medications (like dapsone, ribavirin, sulfa drugs), trauma to red blood cells, or to conditions where the body attacks its own red blood cells (sickle cell, thalassemia, lupus)
3.  liver problems like hepatitis

Increased LDH itself is not a problem, but the cause can bad.  Therefore, the treatment for elevated LDH is to treat the cause.

High bilirubin can be the result of any of the following:

1.  Blockage of the small or large bile ducts in the liver by anything including gall stones, liver inflammation (hepatitis due viruses, drugs or alcohol)
2.  Breakdown of red blood cells too rapidly
3.  Certain medications like indinavir (Crixivan) or atazanavir (Reyataz)

Treatment of high bilirubin relates to treating the cause.  If high bilirubin is due to indinavir or atazanavir, generally no treatment is necessary.

The AST can be elevated due to liver inflammation like viral hepatitis, drug-related hepatitis [sulfamethoxazole, HIV antiviral medications, fluconazole (Diflucan) and many others] or due to drinking any form of alcohol.

The AST can also be elevated due to muscle injury from trauma, heart damage (heart attack), or vigorous exercise.

AST itself is not harmful, but usually the cause should be diagnosed and treated

Increased alkaline phosphatase can be caused by liver problems include medications, hepatitis, liver tumors, and blocked bile ducts due to stones or other causes.  Disseminated MAC infection is a common cause in persons with very low T-cells.

Bone problems that increase alkaline phosphatase include infections and trauma.  They are relatively rare.

It is usually important to diagnose the cause of elevated alkaline phosphatase by doing blood tests and possibly a liver scan with x-rays or sound waves.

Many times the GGT is obtained to see if an elevated alkaline phosphatase comes from liver or bone.  If the GGT is elevated, the likelihood is that elevated alkaline phosphatase is coming from the liver.