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Low viral load tripled in 3 months

Aug 2, 2003

I tested HIV positive in August of 2002, after being infected in March of the same year. I had my first lab in September of 2002 and since then I have gone back to the same lab every 3 months, always at 8am each time.

Results thus far have been (by quantitative PCR):

abs. cd4: 500 / cd4: 29 / vl: 8,400 abs. cd4: 466 / cd4: 24 / vl: 4,500 abs. cd4: 470 / cd4: 26 / vl: 4,900 abs. cd4: 566 / cd4: 26 / vl: 15,900 - last results.

Because my viral load has been very low and my cd4 relatively good, my doctor has foregone meds.

Although I realize that my viral load is still considerably low, I'm curious as to what would cause my viral load to triple in 3 months, while my absolute cd4 also increased?

My doctor said that the viral load fluctuates throughout the day, just as ones cd4 count does. However, I wouldn't expect that big of a difference in 3 months, considering that I have been having the tests done at the same lab at the same exact time of day. BTW, each lab was processed at the same place each time.

I also noticed that on my next set of labs to be done in 3 months, my doctor marked down next to the HIV RNA test, "ultra sensitive V08" - which she has never written down before. Is this a different type of test?

Thanks very much for any answers you can provide.

Response from Dr. Holodniy

The advantage of having several time points is to see the trend over time. The averages for these 4 values is a CD4 count of 500 and a viral load of 8500. Thus, in my mind, nothing has changed significantly. The current acceptable variation in viral load is about 3 times (3 fold) up or down from a number. Taking an absolute viral load value or the mean, leaves your viral load within acceptable variation limits. An ultrasensitive viral load test is a PCR-based assay with a lower limit of detection of 50 copies/ml, compared to a standard test with 400 copies/ml. Given your numbers, there is no need in my mind for an ultrasensitive test. It is best used in those patients who are on therapy and we want to see maximal viral suppression (i.e. undetectable virus at < 50 copies/ml).

Nucleic acid testing

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