|Results going the wrong way!
Jul 27, 2008
Thanks for this great online resource. I am writing for the first time and looking for some answers.
Before I ask my questions, I brief you on my circumstances.
I was negative in December 2007 and contracted genital HSV1 infection between 21 and 23 March 2008. I had an episode of primary HSV infection which took 2 weeks to settle and was associated with anal lesions, swollen lymph nodes in neck and groin, fever and general body ache.
I went for a complete STD panel and was diagnosed with HSV 1 and HIV 1 (Subtype B) on 02 April 2008. Since then I have also had anal warts and suspect HPV infection as well. I have had a very low risk history with use of condoms for anal sex. My doctor says that I have been unlucky to have it through oral sex.
I have had three sets of ELISA and WB tests on different samples on different days but same laboratory and they all are positive.
My baseline CD4 was 819/CD4% 20/ VL 27330 in March 2008. I repeated my tests in June 2008 and the results were CD4 642/CD4% 22/ VL 108000.
Resistance testing has shown no resistance.
I now present my questions
1. How reliable is the HIV diagnosis in view of a simultaneous HSV 1 and HPV Infection? Is there a probability of any cross reaction? I ask this because I have always been low risk and did not have any symptoms of seroconversion between my negative test in December 2007 and 23 March 2008 (when I got HSV).
2. My results seem to be going the wrong way. As you can see my VL has gone up 400 % and my CD4 count has reduced by 22 % but my CD4% has improved by 2%. This appears to be a huge drop in CD4 and a massive increase in VL. I am extremely worried by such deterioration in results in just 3 months, considering the fact that I was negative in December 2007. Could you please comment on my results and what they mean?
3. Can HBV vaccination, which I have received twice in the last 3 months, cause of high viral load?
4. What implication HSV1 and HPV co infection has on HIV VL? Is this a possible cause of my high VL? My doctor is not concerned about the results and in his opinion these are just the same results. Given the results, he still says that I will have many years (at least 3, possibly more) before I start treatment and I have a good possibility of living to a ripe old age. Please could you comment on this observation?
5. Since my diagnosis I have not had a recurrence of HSV 1 and my warts are the same in number and have not increased in size. My warts are the only physically manifest symptom and a constant reminder of my ill health. My doctor has suggested Cryo for it but I have had only one session. Do you recommend Cryo? Is it beneficial? How frequently should this be done? What are your recommendations of using Aldara internally?
6. Is HIV linked to dry and scaly skin and increased sebacious activity on face? I have had lots of acne and my face is scarred. My doctor says it is all due to stress. Please comment.
6. Finally, what do you think is my prognosis in the long term considering that I have HIV, HSV and HPV?
I am sorry for the long list of questions but i am very worried.
Many thanks in anticipation.
| Response from Dr. Holodniy
1. The HIV viral load and repeated HIV screening tests are positive. 2. Although your conclusions are correct based on those two sets of tests, it is too early to comment. That said, your CD4 count is in the normal range, but your CD4 % is low relative to the absolute count. Given that viral load this could be significant but a couple of more sets of labs are necessary to know what the trend is. 3. Yes. 4. HSV yes, HPV unlikely. Although I agree with your doctor in general, another set or two of numbers without acute infections will settle the score. 5. Cryo or aldera are acceptable, depending on the clinical condition. 6. HIV is usually related to dry skin. yes, stress can be a factor. 7. Too early to tell.
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