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undetectable VL, but bad symptoms
Sep 7, 2003

Dr. Young, I'm positive be serology, but they have never found my VL, not even with bDNA or Roche 1.5.

But, I am VERY symptomatic all the time and my CD4's continue to decline (just within normal now), so the virus must be there doing some damage.

Any thoughts on other tests to find the virus itself and also quantify it? If there is a very low viral load (undetectable), is it possible to have such bad symptoms? Have you seen this before...normal CD4 number, undetectable VL, but really bad chronic symptoms?

Any suggestions or advice would be appreciated.

Many thanks.

Response from Dr. Young

Thanks for your question. I have a couple of patients just like you (at least from a lab standpoint). One test that might be worth asking about is a HIV DNA PCR-- this looks not for free, circulating virus, but rather virus that has incorporated into (or within) infected cells. An alternative is to inquire about having your blood sample sent to a university research lab to run extra sensitive tests (there are some that can measure down to about 3 copies).

One of my patients who had undetectable viral loads for years (with a declining CD4 count), finally popped up with true, blue positive RNAs (by Roche 1.5 and 1.0).

So I have to assume that if your doctor has looked hard for other causes, that your symptoms could be related to HIV, even with an undetectable viral load. Remember, an undetectable viral load doesn't mean the virus is not present, only that we don't have tools sensitive enough to detect it.

Good luck. BY


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