Dear Dr. Holodniy, i tested hiv+ in Nov. 2004. i visit my ID Doc every 3mths. my VL have been undetectable from the 1st test to date. <50 (last results, March 2006). CD4 ranges btwn 600-940. this is my story; i met my husband in Dec 2001. we got married June 2003. he's the only partner i've had sexual contact with since then. he is hiv-. we have been on safe sex since day one when i tested pos. 4 different times the condom have broken, yet he always tested neg- to this date. my 2ex-boyfriends are neg- too. i may have been exposed back in 1998 from an ex-boyfriend (i'm only guessing as i can't reach him. he died in a car crash in 2003). i'm healthy & without any symptoms. my question's; 1:is this a normal pattern of VL? 2:what do you think is holding the virus at bay? (i do pray that it remains @bay) 3:how come my hubby never got infected? (I do thank God that he never did!!)i'm a 35yr old female, we hope to have a baby soon? 4: is it possible? 5: and if so, how would it happen w/out exposing him? please bear with me for those many questions. i do really appreciate your time & helpful responses! concerned, NY City.

It is definitely possible to be infected (with a positive screening antibody and western blot confirmatory test) and have an undetectable plasma viral load. Given your CD4 count being in the normal range, it is likely your immune system is able to keep the virus under control with meds. Because you have a very low level of virus, the risk of female-to-male transmission is very low and slightly less than male-to-female. Although we never suggest having unprotected sex because of that reason. It is possible to have a healthy uninfected baby. That should only be done under the strict supervision of an obstetrician who is an expert in handling pregnancy in HIV infection.