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Flu & tetanus vaccination affect on VL?
Jul 16, 1998

I just recently tested positive (WB). I have reason to

believe that the exposure happened about 2 months ago,

due to odd symptoms (headache not responsive to analgesics,

sore throat, slight fever, 1.5 week long malaise) about a week after a <100% safe sexual encounter (unprotected

receptive oral sex (no ejaculation in my mouth, but

partner was, ahem, large and tonsils felt battered). Also,

WB was reactive for GP41 and GP 120/160, P24 reaction

detected, but "below the intensity of the weakly reactive

control"). Above are reasons to suspect infection was

recent.

I went to my GP because I had experienced diahrea about

8 weeks after this encounter (probably no relationship),

and my while my sig. other did, too (we had a 3-way with

the suspected source), he got over it the next day and

was fine. I got over the diahrea, but ended up with a

fever of 102 2 days later, and general body aches and fatigue.

Thought it was the flu or perhaps Hepatitis or Salmonela/e-coli, so I went to GP.

He ran lots of tests, including HIV antibody. Also,

put me on 1 week of Flagil, in case it was something

more nasty. Well, next day (after 1 dose of Flagil) I

was better (no fever, fatigue gone, so probably was

mild food poisoning or flu).

But, HIV test came back +. Last test - HIV test was

three years ago, and this recent one is the first

since then, since I assumed that avoiding receptive

anal sex w/o condom I was safe enough (obviously not).

Anyway, 9 days after having the 102 fever, had blood

drawn for PCR HIV RNA VL test. I told doc, "But I

read you should wait 2-4 weeks after flu to do this

test. "Nah, we better do it now". He also said I

had better get all my vaccinations before HIV damages

my immune response. I said "Can't that affect the

HIV VL test and also speed disease progression by

activating immune cells if I'm not on any antivirals?"

He again said, no, vaccinations are safe and won't

have that big an effect. So he went ahead and gave

me a tetanus booster shot. Blood was drawn for

VL test 3 hours later.

Well, VL test came back as 39,000. However, T4 and T8

test came back "Tests canceled due to laboratory or

clinical error". GP refers me to local specialist.

I have GP office re order t4/t8 counts, and also ask

to redo the HIV VL test, both to see if it has gone

down due to more time since fever episode, or up due

to tetanus vaccination. And also since I've read that

taking 2 VL tests anout 2 weeks apart is a good idea to

establish baseline.

My questions are:

- How might diahrea/fever episode (whatever it was) have

affected VL test 9 days later? 9 days plus 3 weeks

later (2nd VL test)?

- How might Tetanus shot affect the first test (3 hours

later) and also the more recent test (almost 3 weeks

after vaccination)?

- New results are not back yet (just got the 2nd test

yesterday). But what is your opinion about the

validity of using these 2 tests to base treatment

decisions on? Should they both be considered tainted

(#1 due to fever incident, #2 due to tetanus vac.)?

Should I wait a month and have a 3rd VL test, just

to really know what we are dealing with before making

any treatment decisions?

- Was the tetanus shot a bad idea, since the GP did not

really seem to know a lot about what he was doing?

Could this have just effectively caused my viral set-

point to be an order of magnitude higher, making my

risk of progression alot higher, etc.? I am really

worried about this, and wish that I had declined the

vaccination until I had done more of my own research.

Any guidelines or opinions you can offer to help me

and the specialist (I think he's just a beginning

specialist, due to him acting like he really did not

know the effect of vaccinations on VL tests) interpret

the VL#1 and VL#2 tests would be greatly appreciated.

I have a July 16 appt. with him.

Thanks much...

Response from Dr. Holodniy

Concomitant illnesses can affect viral load, particularly for those patients not on antiviral therapy. As best as we know, transient increases of 10 times or more can occur within days, and usually resolve within 2-4 weeks. This has not been studied closely with daily or weekly measurements to know the exact timing of these bursts. It is unclear whether a transient increase caused by vaccination or illness, results in an increased risk of progression of disease. I doubt very much that a tetanus shot 3 hours before the viral load measurement would affect the results. It will not affect your setpoint. Vaccinations are an important part of health maintenance. I support their use, particularly in early HIV when the chances of making effective antibodies are greatest. The first test may be incorrect because of concomitant illness. The second test should be close to where your set point is. If they are wide apart in values, I would get a third test.

MH



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