Nov 2, 1998
Dr. Mark: I know this site is supposed to be limited to viral load questions, however, I admire your expertise in all areas of HIV, so I venture on asking your opinion on some confusion regardng PGL. Medical texts the I've read give conflicting information regarding this symptom. In particular, one text says-"After ARS, a person may remain asymptomatic for up to 10 yrs., with the possibility of only lingering swollen lymphs as the only symptom." Another text reads-"During the asymptomatic period, which can last 7-10 yrs. or longer, there usually are no symptoms. The presence of PGL during this period usually signifies the ending of the asymptomatic period, and the beginning of advanced stage of disease."AAAARRRRGGGGHHHH!!!!!!!! Please clarify for me, Doctor Mark..Thanks
Response from Dr. Holodniy
Don't know if I can settle it for you. Depends on the experts who wrote the piece and their bias toward epidemiology or pathogenesis. Some of the data comes from natural history studies (done mostly in the mid 80's- early 90's) which followed patients with the symptoms and asked the question, what happened to them compared to those who did not have the symptoms. Other studies looked at the lymph node tissue of some of these patients under the microscope and asked somewhat different questions. This doesn't take into account the effectiveness of the therapies we have now, which I think changes the flavor of what is perceived to be PGL now. Some might argue that larger lymph nodes indicate more viral replication. Others might argue that this indicates better immune control because larger nodes indicate more cells being recruited to control the infection. MH
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