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Undetectable RNA PCR
Aug 24, 1998

Hello doctor. Can you tell me if it would be possible to have an undetectable viral load (RNA PCR <400 copies)

3 months after possible exposure, if one had experienced ARS within days of exposure, but has still not

seroconverted? In other words, could viral load be brought under control without the presence of hiv antibodies? If so, how might that happen? Thank you.

Response from Dr. Holodniy

It's possible. The natural history after ARS is still evolving. HIV infection is controlled by both cellular immunity (primarily CD4, CD8, dendritic, and macrophage cells) and B cells which produce antibodies. Some people have more efficient cellular immunity than others. HIV viral load is usually at it's low point by 3-6 months after infection. That usually occurs at the time antibodies develop and the ELISA/western blot becomes positive. An undetectable viral load by PCR and negative antibody test at 3 months could be from antiretroviral treatment which might slow the development of antibodies. If prior viral loads were not obtained to demonstrate a detectable viral load in the absence of antibodies, one always has to consider that HIV infection is not present. If the person has documented HIV infection by some other means (culture, cellular DNA PCR), the test results you describe could be false negatives because of poor lab quality or strains not recognized by the tests. Lastly it may just be the window period in which viral load has declined to undetectable and subsequent antibody testing at 4-6 months will be positive.

MH



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