Dear Dr., (QUESTION 1: Why is my VL so low without meds?) Without any meds, I have mostly maintained an undetectable viral load since 2003, only spiking to 938 once, four times 100-400, and 13 times >75, including now. My cd4 counts ranged from 500-800 and is 633 now. (QUESTION 2: Is my CD4/CD8 inversion significant?) While my cd4/cd8 ratio began at 2.0, it has now inverted to .84. However, my CD4% has only declined from 50% to 38% over the last 5.5 years. Thanks!

1. Given that your CD4 count and percent are in the normal range with an undetectable viral load, it is likely that your immune system is able to control the HIV infection on its own with HIV meds. 2. Although you don't indicate what your CD8 count is, it is likely that the ratio has decreased as a result of an increased CD8 count ( a normal reaction to HIV infection).