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Elusive viral load-part three
Oct 11, 2003

Dear Doctor Holodniy,

Many thanks for your answer to my posted question on the elusive VL. I am not sure if this changes your answer, but you mentioned that I have an undetectable viral load during "acute infection". Actually, it is more than a year after exposure and the first harsh symptoms, so I really have had an undetectable VL during chronic infection. At the time of primary infection and acute symptoms, they did a couple of RNA PCR tests (also negative), but a bDNA was only done at 6 weeks post onset of symptoms and at 6 months after. So, the VL tests during the acute phase were not ones to detect and quantify non B subtypes (which is why they may have missed the viral load).

Also, you suggest a DNA PCR test for virus in cells. As mentioned in my prior answer I have had these done - at 3 and 10 months post exposure. Would you recommend a repeat of the DNA PCR at this later stage...could it show virus in cells much later?

It is a puzzle - so many viral symptoms, a low CD4/CD8 ratio due to highly elevated CD8 cells, and a very much lower CD4 percentage. But, no trace of the virus in plasma or in the earlier PCR DNA tests.

Your advice and thoughts on possible tests would be much appreciated. Would you recommend a biopsy on a lymph node? What if I have the 'flu vaccine and then test a week later ? Could that raise viral levels and help finally find the virus itself? (or could thatr esult in a false positive VL result?). Are there other viruses that could cross react with an ELISA/WB test and depress a CD4 percentage and ratio? (like CMV??).

Many thanks for all your help.

Response from Dr. Holodniy

I would be interested in knowing what bands were positive on the western blot test and how many times this test was repeated.



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