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Long Term Non-Progression?
Jun 29, 2014

I was recently infected (~6 months), and have been seeing an HIV specialist. Initial blood tests have looked awesome. I don't know extensive details of all my results, but after two rounds of blood work, my doctor has indicated that he is not seeing any of the characteristic HIV damage (anemia, etc.) They drew 22 vials of blood and he tested everything in March. His interpretation was that all of my blood tests were normal or better than normal. My VL in March was ~39,000 copies and my CD4 count was 1141. In June, my VL was ~35,000 copies and my CD4 had jumped to 1435. My doctor took these are incredibly positive signs, and indicated a belief that the absence of damage or disease progression could indicate that I may have some genetic receptor-based protections from the virus. He said that if the virus was successfully doing what I normally does, my CD4 would be lower, and my viral load would be through the roof (1 million +, in the absence of meds). He indicated that until he sees a drop in my CD4 (perhaps to the 900 range) he would never prescribe meds because I don't need them (in his view). I took this as incredibly good news, as who doesn't want a get out of jail free card? But things I have learned from others with the illness are making me question this. I am specifically concerned that perhaps the jump in CD4 is not indicative of just a strong immune system, but a significantly overworking immune system. I have no way to baseline without knowing pre-infection numbers. Even still, I wish I understood the genetic mechanisms at work, if any, so that I could know if I did indeed have some kind of receptor-based protection or not. I don't want to take no action based on an assumption, and then end up with a burned out immune system or other neurological and physiological effects down the road because I could have treated it early and controlled the virus.

So my question is, based on what I have said, do you think my doctor's assessment is premature and how would you interpret the information?

Response from Dr. Holodniy

Although your CD4 count is within the normal range, your viral load is in the moderate range currently, and given recent infection, these numbers do not indicate longterm nonprogressor status. Most people with this status have had undetectable viral loads in the absence of HIV treatment and normal CD4 counts for several years. There is no real difference in those two CD4 counts. Having a detectable viral load like yours indicates that your immune system at this point is not able to control viral replication on its own. There is no urgency to start HIV treatment, but most experts would agree that even with a normal CD4 count, if you continue to maintain detectable viral loads, HIV treatment would be indicated to shut viral replication off and preserve immune function.



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