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Seroconversion and Acute HIV infection Question

May 27, 2007

Dr. Holodiny,

I have a question concerning seroconversion and Acute HIV infection. In a sense it is more out of curiosity than anything else at this point since I started meds over a year ago.

Anyway, My VL more than halved from my first test in Jan 06 to the test just before I started meds in April of 06. My CD4 had been declining, but took an upturn prior to starting meds. My CD8s had been fairly stable but took a big jump just before I started meds.

In Nov 2005 I had a cough that was diagnosed as bronchitus by a local doctor (not my regular doctor). I had noticed some swollen lymph nodes on the back of my neck on the right side. I was given antibiotics and within a couple of days I had significantly swollen lymph nodes on both sides of my neck. In Dec of 2005 I noticed that I had swollen lymph nodes in my groin and on the underside of my chin. I went to my regular doctor and she expressed concern. She ran a battery of tests, one of which was an HIV test. The HIV test came back positive on Jan 9, 2006. My first 4 sets of labs were as follows: 1/17/2006--CD4 455, CD4% 16, CD8 1998, VL 144,000; 2/27/06--CD4 376, CD4% 14, CD8 1895, VL 87,512; 3/17/2006--CD4394, CD4% 14, CD8 1998, VL 76,753; 4/10/2006--CD4524, CD4% 12, CD8 3144, VL 65,814

Just wondered if you could shed any light on whether I could have been in the early stages of infection where my body was fighting hard and beginning to get things under control or if those numbers tell us anything at all.

Thanks so much for the job you do here!

Response from Dr. Holodniy

Unfortunately, they don't tell me that much. The drop in VL from 144,000 to 76,753 is actually within assay variability. So is not a significant drop. The increase in absolute CD4 count from 376 to 524 is also not significant, given the CD4 percent actually went down. The absolute CD4 count is more variable and the percent is a more stable number over time. Of significance though is the CD8 increase. The doubling in number does reflect your immune system's good reaction to fighting the virus.

Replication Capacity (RC)

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