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Worried about VL results
Aug 26, 2005

Hi Doctor, I have recently been diagnosed positive and have had two lots of results. Two weeks ago I had a viral load of 200,000 and a CD4 count of 420. Percentage 16. Today I have had other results. the viral load has stayed the same. There has been a reduction in CD4 count to 320. The Doc said that the total number of lymphocytes had reduced by a 1000. Is it likely that my viral load will remain at this level, or reduce without meds. Reading other messages / questions on this site makes me think my viral load is quite high. I was very ill about 3 months ago. I suspect this is when i seroconverted. Are viral loads generally higher during ARS?

Response from Dr. Wohl

Soon after HIV enters the body it reproduces at a high rate. The virus thrives in T-cells (CD4 cells) and there are plenty of these cells responding the infection. Unfortunately, these cells are just what the virus needs to replicate. The virus infects them and uses the cell to make more copies of itself, often killing the cells in the process.

So early in HIV infection, lots of virus is made. Over a short period of time (weeks) the virus level starts to fall and then reaches a plateau or steady state that is largely unchanged through the course of untreated HIV infection. This drop in the viral load may be due to several factors including the ability of the immune system to partially contain the infection.

By 3 to 6 months after infection, I would expect the viral load to be at its steady state. A viral load of over 100,000 is high and predicts a faster decline in T-cells than if the load were lower.

It is important to try not to hinge huge decisions on a single test result. A repeat viral load test would be prudent and will let you know if this first result was accurate and confirm if you have reached the point where the viral load is expected to be stable. Note: the viral load test has some variability or wiggle room such that the same specimen of blood tested again may be as much as three fold different then the first test. So, if your result comes back as 400,000 or 100,000 that would not be an appreciable difference from 200,000.

Lastly, a word about CD4 cell counts. Your absolute number of these cells in a drop of blood did drop. But, it will be important to know if the percentage also declined. The percentage is the proportion of your white blood cells that are CD4 cells. IF it is still around 16%, this 'drop' may not really mean much as the second reading was taken on a day when you just happened to have fewer white blood cells (a level that can fluctuate).

I hope this helps.

DW



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