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Use of Western Blot Interpretation scoring

Apr 29, 2001

I will apologize in advance for the length of this question and its supporting info. I was diagnosed with HIV 2 years 9 months ago. I have good reason to believe I caught it very early on (neg test 6 months prior to my first poz test). My first positive Western Blot test came back with an Interpretation Scoring. I am not sure if the scoring is lab dependent, but it scores the reaction from 0 (no reaction) to 4 (very strong). The initial results were: p18 1 p24 3 p31 0.5 gp41 3 p51 1 p65 1 gp120 2 gp160 2 My initial VL was 320835 and TC of 485. I had a repeat test done 2 weeks later, and my VL had jumped to 431432 and TC of 515. I was immediately put on a regimen of Zerit, Epivir and Viramune. I had been taking this for almost 2 years and have had great results with consistent TC > 1000 and VL < 50 . At this point I decided to try a Structured Treatment Interruption (STI). Just prior to starting the STI, my VL was 35 and TC 1112. I also had a Western Blot done, just to see if the Interpretation scoring had changed. The numbers were slightly different than the one I had done 2 years prior, but nothing major. P18 0 p24 2 p31 0 gp41 0.5 p51 2 p65 2 gp120 1 gp160 - 3 End of the first month into my STI, my VL - 23 and TC - 999. End of month 2, VL 1795, TC 1036. End of month 3 VL - 2462, TC - 987. End of Month 4 VL 21482, TC 807 End of Month 4 + 2 weeks, VL 276,003 I also had a Western Blot done, and the numbers were interestingly higher. P18 2 P24 3 P31 3 Gp41 3 P51 3 P55 1 P65 3 Gp120 2 Gp160 3 At this point I immediately restarted my previous meds of zerit, epivir and viramune. One month after restarting, VL 810 TC 852. Two months after restart, VL 254 TC 1003. I am going for a blood draw next week. I am also going to have a western blot done again.

My questions: 1) Can the western blot interpretation scoring be used as a gauge of how well the body is developing an immune response to HIV? 2) I have had several extended Tcell tests done, the most recent one done during my STI, indicating 91 (which is marked HIGH). Does this indicate that my body is still capable of creating a strong immune response? 3) Is 4 months an unusually long time for viral rebound (considering a first time STI)? And is that a good indicator that a follow on STI might have even better longer lasting results? 4) If all goes well with this next blood draw, I am most likely going to start a second STI. Is it too soon to do this again? 5) Are high TC and low VL results indicators that my immune system has recouped enough to deal with another STI now, or should I wait longer? If so, how much longer should I wait?

Thanks for any info you can provide me.

Response from Dr. Holodniy

Although I would never advocate individual patients do what you have done, it does provide interesting objective data for the questions you pose. #1. No data to answer this. I suspect the numbers indicate a scoring system of 1-4+. This is related to the color intensity of the band for each antibody. The results are assay kit and operator dependent, as this is a visual scoring system. #2. I am not familiar with what that scoring system means. #3. We are just beginning to understand what the kinetics of viral rebound are in STI. From the data to date, 4 months would be on the long side, and may indicate the effectiveness of your immune system in containing viral replication. We don't have the definitve answer for subsequent STIs. Some folks have gone back to baseline, others have maintained lower than baseline viral load levels. #4. Many strategies are currently being looked at, ie, 3 months on, 3 months off, or 7 days on, 7 days off. #5. See #3. I can't currently recommend what you should do, since there is not enough data. MH

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