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what Viral load is statistically significant?
Jan 3, 2002

2 questions... first of all i am highly allergic to everything . a friend of mine says that because of my highly sensitive reactions, my immune system is hypersensitive. i have gotten cd4 results of 1565 before going on meds. Is there any known co-relation to individuals who are highly allergic and cd4 levels and if so the ability to combat hiv more effectively with/(out) meds?

question 2. I have read alot on STIs, and know that testing is still ongoing and the "jury isn't completely out" on what works and what doesn't. My viral load is very low with a baseline of about 5K. I am recently infected less than three months (testing negative on the detuned hiv test) however, contrary to standards of care, I decided that I wanted to go on meds Combivir/ Ziagen to protect my lymph nodes, (there was never any early symptoms of fatigue, weight loss, or enlarged lymph nodes -- the only thing i could think of was a wierd feeling in my tongue without any external signs of infection) and to be in the window period of benefiting from STI treatment by being on meds early in infection. I had preliminary effects of neuropathy in my hands and feet which have abated for the most part. I am associated with a research study with a pvt dr. and my doctors seem to be of an opinion that the benefits are insignificant since my viral load baseline is so low. My 2nd. question is: if my baseline viral load is 5K, is a lowered number of lets say 400 satistically significant in the world of viral loads. I am an accountant and i would like to put these numbers into perspective.

Thanks and have a healthy happy safe stressfree blissful holiday season!

Response from Dr. Pavia

Good questions. First, is there a relationship between drug allergies and outcome? Not to my knowledge. The type of immune response associated with allergy is generally felt to fall within the category known as TH-2 which is not the general type involved in fighting HIV. A highly allergic person might fight the virus very well without meds, but also might not.

The question of how much change is meaningful is an important one. In general, viral load changes should be interpreted in terms of the log 10 change, or for those of us who prefer simple ways of thinking about it, the fold change rather than the absolute change. A 0.2 to 0.3 log change is reproducible based on the accuracy of the assay, so you might say it is 'statistically significant' in the mathematical sense. But, you need to account for day to day variability as well as test accuracy. Therefore, a 0.5 log or 3 fold change is the minimal we consider biologically significant. So, going from 5000 copies to 1300 copies is a 3 fold or about 0.5 log change and enough to matter somewhat. Going from 5000 to less than 400 is at least 1 log or 10 fold, and yes, it is meaningful.

However, people with less than 10,000 copies progress very very slowly. There is a detectable difference in progression rates between 5000 copies and 400 copies, but both groups do very well for a long time.

I hope this helps

ATP



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