I have been positive for 22 years ( I am from the time of the "gay cancer"), and have never been sick. I have also never had any kind of medication for HIV. At the moment my CD4s are 170, and my viral load is undectetable. What should I do? Thank you

This is an unusual situation. I wonder if your viral load has always been undetectable when checked.

If so, could the test be missing something such as HIV-2 (a much less common type of HIV that is found in parts of the Carribean and West Africa)?

I would consider an evaluation at an academic medical center with heavy HIV experience. There are sophisticated tests that can be performed to try and identify low levels of HIV (below 50 copies). In addition, antibody testing to HIV-2 can be accomplished.

If all else fails, a trial of HIV therapy may not be too absurd. A 6-8 week course, if found to increase you CD4 cells, would suggest that on-going virus replication was contributing to your CD4 decline.

Regardless, you should be on medication to prevent PCP pneumonia starting now.

DW