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High viral load and reasonable CD4 count for 2 years

May 4, 2014

Dear Dr. Holodniy, greetings from Buenos Aires Argentina. I am a fit 36 year old male that was diagnosed 2 years ago, I have never been on meds and I believe that I seroconverted in June 2009. Since my diagnosis (2 years ago) my 3-month screenings have always shown a viral load in the 4.8-5.1 log range, and a CD4 absolute/relative count around 800/32%. These numbers have been completely consistent for the past 2 years. I am fully aware that this creates an ongoing inflammation response which may lead to non-HIV-associated issues (increased cardiac risk and certain cancers, etc). My Westerngreen ESR has always been between 10 and 15 mm. I suspect that you will answer that sooner or later the VL will increase and the CD4 count will decrease. If that is NOT the case, would it be risky to remain like this for a few more years? Also 2 years ago I started eating a lot of oats. Oats contain saponins that have been proven to inhibit the replication of HIV in vitro, could this be causing the VL and CD4 counts to remain stable for the past 2 years?

Response from Dr. Holodniy

You obviously have a very good understanding of the issues associated with HIV infection. The ESR is one global measurement of inflammation, but if your blood were to be tested in a research lab, I suspect that if more sophisticated measurements of inflammation were were tested you would see those biomarkers being elevated. I can't comment on your oat theory, but sounds interesting. You are correct about my response. Given the overwhelming evidence from natural history studies demonstrating what happens when the viral load is that high over time, I think it is not a question of if, but when, you will begin to see a decline in CD4 count.

Atripla with food and Viral Load
Atripla with Food and Viral Load

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