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<20 "detected"

Jul 5, 2014

Hello, Appreciate your time answering my question. My last lab report was a CD4 of 957, Viral Load <20 "detected" and CD4 percentage of 38%. Had a rough week of manual labor at work on no sleep. Also, fasted 10 hours before to check cholesterol. What does <20 detected mean? The doc considers it "undetectable". Does this Quest lab report mean they can detect the virus but its still less than 20? My current lab report just came back and Cd4 is 567, 37% and the <20 "detected"? Is this drop in CD4 number normal? Can the fasting have something to do with it? I was a little under the weather at the time of testing. Thank you for your time!

Response from Dr. Holodniy

First, I agree with your doctor and I am not concerned. Current viral load assays have now been recalibrated to be able to detect, but not quantify viral load < 20 copies/mL. This has created a lot of problems for practitioners and patients as to what that means and if it means that current HIV treatment is no longer effective. The published literature is mixed on what this all means. Some studies indicate there is a higher rate of failure if any virus is detected and other studies have not shown this. It does not appear that adding additional HIV meds results in completely undetectable/unquantifiable HIV viral load. So most of us are just watching patients closely but not doing anything at this time. I am also not concerned about your CD4 count drop, given the undetectable viral load and stable CD4 percent.

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