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Virus Confined to Lymph Nodes in Primary Infection?
Oct 5, 1998

Dear Dr. Holodniy, I had a high risk exposure (receptive anal intercourse/condom break) with a gay man who later tested HIV positive. About a month later I experienced some of the symptoms associated with ARS. Concerned about my HIV status, I had a battery of tests at 4 weeks - p24, bDNA, and ELISA. All came back negative. The symptoms persisted a few weeks then faded. I still have low level fatigue, some slight swelling of an axilla node, and pain in one of my elbows though. I followed up the 1 month tests with an ELISA and HIV-1 DNA by PCR at three months - negative. Just last week I received another negative ELISA (22 weeks/5.5 months). Needless to say, I began to breathe easy and ascribed my symptoms to a passing bug and/or stress. However, today I read an article that concerns and confuses me. The article discusses Dr. Ho's and others' discovery that HIV begins to reproduce almost immediately in the host rather than lie dormant for many years. The article goes on to state, "This replication [goes] largely unnoticed because it occurs in the lymph nodes, safely out of sight of traditional tests that measure the amount of virus in the blood...By the time the virus shows up in the bloodstream, it has usually destroyed the lymph nodes, along with any real chance of saving the immune system." I thought that the bDNA and HIV-1 DNA by PCR screens could detect infection at an early stage. The doctor at my medical group (which handles many HIV and AIDS cases) in LA assured me that the PCR screen would detect viral load in the blood. Is it possible that viral load would not show up in the blood of some non-treated, primary stage infected people because the virus is confined to the lymph nodes? If so, how is it possible to accurately test for the presence of HIV in these people with blood-based tests? Would antibodies be present in the blood even if the virus was confined to the lymph nodes (ie. virus not present/measureable in the blood)? Sorry for the length of the question, but I am hoping to get an early start on treatment if in fact I am infected.

Response from Dr. Holodniy

I agree with your doctor. I am not sure what article you are refering to that David wrote. Was this a study in a journal, or an opinion piece? All the acute infection studies published to date in which the timing of infection was known, have demonstrated very early (days to a couple of weeks) detection of blood viral load(as plasma viral load, or infected cells). MH



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