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Are We Still Just Guessing?
Jun 19, 2005

Good morning Doctors,

Thanks for this very helpful and anonymous site.

I am now at 2 1/2 years off meds. I have been part of a study group since my seroconversion just over 5 years ago. This is my third and longest supervised interruption. The previous two only lasted 10 weeks each.

I have a question about the V/L tests currently being used. The PCR and the NASBA. How can they both be legitimate when they render different results from the same patient and the same blood draw? Quite accidentally the wrong test was used for my last blood draw and bore a V/L count of 29,000. When they discovered they used the wrong test, they ran the alternate test with the same blood which bore a V/L count of 9,000. This result was presented to me with a Youll be happy to hear that. Can you help me understand this disparity? Can you also help me understand why I should be happy to hear, or give more weight to the second result than the first, knowing that both are legitimate? Logic shouts that if the tests are both correct, then they are also both incorrect. This leaves me, the patient, without a point of reference. It also makes me wonder if any of these numbers really mean anything.

For the last 6 months I have been eating poorly, exercising less and smoking more. In short, my temple is a mess. Yet, according to the results of the correct test, my Ts climbed and my V/L dropped by 20K. This makes no sense to me. The results of the wrong test make more sense in the cause & effect world.

Can you help me to understand how I can use these numbers to manage my HIV infection? Or, can you direct me to a site that can? Isnt there a HIV for Dummies out yet? Or are these numbers meaningless and are we still just guessing?

Thanks.

Response from Dr. Pierone

Large blinded studies have been performed to standardize the different methodologies and there is fairly good concurrence of results. However, in any one individual there may be a poor correlation between the different tests, especially with low range viral loads like yours. This is one of the reasons that clinics try to use the same testing methodology (HIV PCR, bDNA, or NASBA) in order to avoid disparate and confusing results.

Viral load testing provides a general measure of the level of viral activity and is just one of the tools for managing HIV infection. Other important considerations include clinical symptoms, CD4 lymphocyte count, CD4 cell percentage, and the slope of CD4 count decline. A viral load in the 10,000 to 30,000 range is considered low and suggests a favorable prognosis.

Finally, CD4 cells and viral load readings cycle up and down are not strictly governed by the exercise, diet, and drug use. But the overall health benefits from smoking cessation, healthful diet, and vigorous exercise are undisputed.

For HIV information there is a ton of information of this web site (it would take weeks to read it all) and the other HIV educational sites that you will find links to. Thanks for posting and best of luck to you.



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