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PCR and Recombinant HIV
Aug 10, 1998

Dear Doctor: You said that ELISA tests were pos with respect to the infections with "recombinant" strains identified to date. My question is whether PCR tests could quantify viral load in patients infected with these strains or whether the mixed nature of the strains rendered them undetectable by PCR. Also, would it be fair to say that there is a finite amount of genetic mutation that HIV can undergo and still be HIV? In other words, aren't there certain basic genetic characteristics of HIV that are required in order for it to be able to infect T-Cells, reproduce itself, etc. and that therefore could always be detected? I guess I am worried about the chances of infection with some variant that would be missed by all current tests. Thank you.

Response from Dr. Holodniy

Most current viral load tests would be able to detect these recombinations. The current tests are designed to use molecular probes that attach to parts of the virus which are "conserved" genetically. That means that these parts of the virus evolve or change very little compared to the other parts (outer envelope coating the virus) which change alot. We know the virus clearly can make mistakes as it copies itself, which result in mutations. Some of these render the virus unable to replicate. Others can make the virus more fit to replicate. Drug pressure clearly makes the latter happen as well. To date, at least in the US, using a combination of testing strategies, it would be highly unlikely to find a strain that we could not detect. MH



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