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Jan 5, 2014

Ok so we all agree today's ART has improved lives dramatically but I have a few questions. First, if the average person has 7 pints of blood and there are roughly 473ml in a pint and that same persons vl came to 25 (or essentially UD) that would still meant there are roughly 87,000 viral particles in the blood alone, correct? What is ART's effect on them? Or, to put it another way, what is their effect on the body? I am recently diagnosed. Vl of approx 4000 and cd4 of 788. How long would you guess I have been positive and should I go on meds? And a last question, if you were to prescribe a regimen with these numbers (assuming all other functions were normal) which would it be?

Response from Dr. Holodniy

There is another component to your algebraic equation on viral load quantitation. In addition to cell free virus in blood, there is the cellular component, which includes the integrated provirus form and possibly intracellular virus particles in circulating mononuclear cells. This component has not been directly, but indirectly quantified, and likely adds a few hundred to many thousands of copies per million cells. In general, current ART affects the cell free component by shutting down replication in the infected cell pool. Current ART does not affect the total cell count of infected cells that are still circulating. This is the subject of intense research currently. Namely, how to detect and destroy this reservoir pool. I cannot say with any certainty how long you have been infected. Although your viral load and CD4 count are proxies for how well your immune system is controlling the virus, these numbers don't date the infection. There are several HIV treatment options which have been found to be of equal potency. Choices are determined by a variety of factors including other ongoing medical conditions and medications that might be required for them that could affect or interact with HIV meds, convenience, baseline drug resistance profile of the virus strain, among others. For the complete recommendations, you can go to this US guidelines page:

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