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Rate of replication
Sep 8, 2002

Mark, Has anybody looked into the rate of replication of the virus as a significant number to measure and monitor? I am asking this question because, by looking into a graph that describes early infection I noticed that symptoms appear as viral load increases, and disappear when antibodies are generated and viral load decreases. However, since ARS occurs only once during infection and viral load increases afterwards during the course of the disease, howcome ARS does not appear again? It could be because hiv-specific antibody generation starts only once, but that would not explain people who never experience ARS. As a matter of fact, late in the disease, viral loads sometimes do not completely explain the observed clinical manifestations of advanced-hiv disease (or at least my understanding is that it varies a great deal), but how about viral replication rates? In other words, how important is that the virus, no matter how much you've got, is dormant, or replicates slowly, as oppossed to being very active and replicating rapidly? Say for instance a person's viral load is high. That could be a high viral load with a low replication rate and a resistant strain, or a high viral load resulting from a virus that is being destroyed by medications but replicating aggressively. How would you be able to measure replication rates? Thanks for your comments and patience!

Response from Dr. Holodniy

It is difficult to measure replication rates. Most of the numbers generated are by mathematically modelling replication rates after people start treatment, where the rate of decay can be quantified. But this only looks at the plasma compartment and further speculation must be used to quantify replication levels in lymph nodes and other compartments. After acute infection, the plasma viral load does not appear to be a good correlate with symptoms during chronic infection. Many people walk around with viral loads in the 100,000s and don't have symptoms. So the level of virus is only part of the story.



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