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Continued drop of VL?
Aug 2, 2003

Doctor -

I was diagnosed HIV+ in April, '03. At that time my numbers were vl 297,000 CD4 320. My doctor recommended waiting and watching as I felt fine and my tcells were not too low. 6 weeks later I was vl 302,000 CD4 421 and again my doc recommended waiting and watching, as he believed I may have been "spiking." 6 weeks later (most recent) I was vl 192,000 cd4 450. While I was apprehensive and anxiety ridden about just "sitting as the clock ticked" I am glad I followed his advise and did not go on medication, as our hope is that I did spike and my body is now finding a way of fighting the virus on its own.

My questions are: with a viral load that went that high, can I have any expectations about how low it might drop on its own without medication (is undetectable a conceivability, or fool's hope), or is that entirely dependent on my own immune system and the virus? Is there a "norm" for how high a viral load goes when it "spikes" or statistics for long-range planning with this scenario (i.e., how long I might be able to go without medication if the vl continues to drop)?

Many thanks, KMB

Response from Dr. Holodniy

Beleive it or not, those three viral load numbers are essentially the same. There is actually no "spiking" going on. The acceptable tolerances for viral load variation are around 3 times (3 fold) for a given level. Viral load assays are thus not that tight in terms of absolute numbers. Thus, the difference between 297,000 and 302,000 is just noise in the assay. Also given that level of viral load, I am concerned that you will not get the levels down on your own and that treatment will be necessary sooner rather than later.



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