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Is a normal CD4 level and undetectable VL usual for the first 2 to 3 years of infection?
Dec 28, 2003

Dear Dr. Young,

I see a lot of people who say they are hiv positive writing questions to various body.com forums as well as to other websites....they indicate that their cd4's are well within normal, such as 1,000, and that they have no detectable viral load without treatment, even 2 to 3 years after diagnosis.

can you please advise if you encounter this often, whether it is unusual and roughly what percent of hiv poz people are in this category. does 2-3 years of such history show that these lucky people are long term nonprogressors or have weak strains of the virus...or are normal cd4's and undetectable vl's for 2 to 3 years the natural course for hiv?

Many thanks and happy new year.

Response from Dr. Young

Thanks for your question.

We have seen a number of posts about such situations. It is very, very important for our readers to know that the situation of having a high CD4 count and undetecable viral load is highly unusual. For example, in our office (where we care for roughly 1000 HIV-infected individuals), I can think of 3 who fit this situation. That means that in our office, the frequency of this situation is 0.3% (or ~1:300).

Based on large observational studies (and the experiences of our patients, too), these persons have very slow disease progression. That is not, however, to say that they will not have disease progression, and indeed, one of our three individuals has had CD4 cell decline and has started on treatment, even with a viral load that has climbed all the way to 500-1000. BY



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