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Long term nonprogressor, but very ill
Apr 18, 2004

I am what they call a long term nonprogressor - at least, since diagnosis, I have had an undetectable VL for a few years without therapy and normal CD4's(>900 as of last T cells subset).

But, I have been incredibly ill from the start of infection...for almost three years, I have had really bad symptoms almost every single day. Yet I read of people who say they feel well with single digit CD4's and high VL's.

How can this be?If I have low enough levels of HIV in my plasma by bDNA and RT-PCR 1.5 assays (undetectable), shouldn't I feel better? if I have a strain of HIV that is especially bad, wouldn't it be attacking my CD4 cells ruthlessly?

Can HIV be totally ruled out as a cause of symptoms in a case such as mine or can it do a lot of damage in thelymph nodes and elsewhere without ever showing up in VL tests? Symptoms include frequent difficulty breathing (can HIV cause asthma and how does one test for it?), weakness and nonresponsiveness in legs, chronic pharyngitis (throat feels blocked), painful lymph nodes (but never swollen since primary infection), burning and very clammy skin, diarrhea, amazing nausea often...

Test for other suspects have been negative...Hep B and C, colon cancer,etc. Tests such as for C Reactive Protein, chromogranin, CPK enzyme, MRI and Pet Scan have been negative, so I don't know where to turn. I literally feel as if I am dying a very slow and truly agonizing death - the symptoms are that bad...and I fight back every day, show up for work and suck it in as wellas I can. But, I have no quality of life like this and the symptoms get worse (though there are occasional spurts for a few days where I feel a little better - though not well - as if my immune system is rallying...then the nightmare comes crashing back).

With an undetectable VL and normal number of CD4's, can HIV be ruled out as a cause of these symptoms?If not, how can one track into HIV as a cause? Is it viable to extract cells from lymph nodes to analyze them? Any significance to a positive blood smear with reactive lymphocytes? A skin biopsy showed lesions like those of cutaneous lupus, but tests for systematic lupus were negative.

So, I don'tknow where to turn- I cannot convey how bad these symptoms are and I would do anything to feel well again. So, your advice - can HIV be ruled out if I have an undetectable VL, how can I feel this ill with an undetectable VL...what tests would you do if I were your patient...are there tests you would do to rule out lymphoma or leukemia and what would they be (I thought the chromogranin test and CBC covered that?)? Any advice and perspective you can give would be very appreciated.

Many thanks.

Response from Dr. Pierone

First off, it is very unusual for persons with HIV infection to have a high CD4 counts and undetectable viral load. So your situation is rare to begin with. There is no way to prove that HIV is not causing your ongoing symptoms even though the viral load is undetectable. The treatment guidelines for HIV that discuss threshold for initiating therapy focus on asymptomatic persons. For those with symptomatic HIV infection (which yours may be) therapy can be started sooner. If you begin HAART and feel better within a few weeks then you will have your answer. This is worth discussing with your doctor. Good luck!



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