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Answers to your questions re elusive viral load

Sep 28, 2003

Dr. Holodniy,

You asked some questions in a post responding to my concerns about bad symptoms and declining CD4 counts - but inability of tests to find the viral load.

The answers are: testing was by repeated serology, licensed ELISA with viral lysate/WB kits. The CD4 count went from 890 10 days after infection to 580 in 6 weeks, then started climbing back till it reached 1,200 6 months later. The CD4 percent was 40 just after infection and it went up to 48 by 6 months later (when the CD4 count peaked at 1,200). Then, the CD4 number and percentage started declining and, in the next 6 months (year after infection) has gone down to 520, with a CD4 percent of 32. From the first time the CD4/CD8 ratio was measured (10 days after infection), it was 1 and has ranged from .9 to 1.1 every time it has been measured (probably 8 T cell subsets)...the one constant. When the CD4's went up, the CD8's went up too, always bringing down my ratio to the .9 to 1.1 range.

The bDNA test at 6 months, PCR DNA at 3 and 10 months and Roche 1.5 at 12 months failed to detect a viral load. But, I still have REALLY bad viral like symptoms and the CD4 percent has declined 16 in 6 months and by nearly 700 CD4 cells.

The virus must be there somewhere, doing damage, so I would really appreciate your thoughts and advice on my situation - are there tests on plasma, cells, spinal fluid, semen or (lymph node?)tissue that are more sensitive and could help find the virus directly?

I would be glad to think I was a non progressor, but for the many symptoms and falling CD4 numbers and percentages as well as a low ratio.

Many thanks.

Response from Dr. Holodniy

If you have positive results on an HIV-1 EIA and western blot, than infection with a known strain/subtype appears to be present. This would be extremely unusual with a negative viral load result, using two different platforms, during acute HIV infection. It is theorectically possible that you have had a robust immune response and have cleared virus from your plasma. Virus should still be present in your blood cells. Thus a DNA PCR test to look for virus in your cells could be one other way to look at this. Another theorectical possibility is that this is an aborted infection. Many more tests would have to be done to determine such a possibility.

T cell fluctuations

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