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Low VL due to CCR5 mutation
Oct 5, 1998

I wrote on Sept. 28th (Primary infection & low VL, but scared). I just found out that I have the CCR5 mutation (heterozygous). I guess this means that while I am infected with HIV, I'm missing the CCR5 "docking port" on half of my macrophange cells. This makes it harder for the virus to replicate in my body. This supposedly explains my low VL just two mos after initial exposure (approx. 2000 using ultra sensitive test). This gives me some hope. Can I reasonably expect my VL to decrease further since I'm so recent and haven't yet reached my "set point"? Does this mutation argue against initiating HAART right away. My CT4-cell ratio is 50% (980) which my doctor said is "robust". Thanks for answering. I've read that about 10% to 15% of caucasians have this mutation, so I'm sure others would be interested in your response!

Response from Dr. Holodniy

The discovery of these co-receptors for HIV on mononuclear cells is very recent. The additional finding that deletion mutations lead to changes in the structure/function of this co-receptor and hence cell infectibility to HIV is also recent. This finding explains in part some differences in the ability of people to become infected and the rate of progression for those who are infected. Most of the data obtained at this point is retrospective (looking back) from samples obtained from people infected some time ago, and looking at who progressed and who did not. Your question is a good one and not answerable in the short term. To truly answer the question would require a prospective study with several people who have this mutation in which half the people get HAART and half get nothing. They would need to be followed for several years and see whether clinical outcome had been altered by starting therapy earlier. Personally, given the information you have stated, I would wait. Your T cell count now is near normal and we don't know yet what your set point level will be. The purpose of HAART early is to preserve immune function (by preserving T cell numbers an turning HIV replication off). Since you would be starting at near normal levels, I'm not sure what there is to gain.

MH



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