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RE: "Fishy Labs"
Apr 30, 2007

Dr Wohl,

Thanks again so much for your clarity. Your answer regarding the "statistic variation" of the VL count gives me some comfort.

I had understood that an "order of magnitude (X10)" rise or fall was significant, but I didn't understand that changes within a "band" of that order were just "normal" variability.

So let me restate this to test my understanding:

The VL "count" is pretty much to be read by the particular "band" that it is in.

<100 Band one: Goal! With <50 considered "undetectable"

>100<1,000 Band two: Not on treatment: Body responding well. Manageable. On treatment: possible "resistance" of some of the medication(s). Resistance testing recommended?

>1,000<10,000 Band three: Active viral activity

>10,000<100,000 Band four: Moderate viral activity

>100,000<1,000,000 Band five: High viral activity

>1,000,000 Band six: Generally "Acute" phase viral activity

Response from Dr. Wohl

More bands than at Woodstock. I kind of like the whole band idea of yours. Some added calrification, though:

The viral load test does have wiggle room such that the actual amount of virus could be a bit higher or lower than the number reported. The degree of variability is fairly small given the range of the test (e.g from 50 to 75,000). Typically, the variability is described as being within about a factor of 3. So that a result of 3000 is not likely to be different than a result of 9000.

Any viral load can occur on therapy or off. There are many people walking around with a viral load less than 50 on meds and some folks with a viral load of less than 50 not on meds. In heavily treated patients with few med options left, a viral load of 1000 may be considered adequate. So it is hard to say that a particular viral load is good or bad as it depends on the context.

That said, a high viral load can never be a good thing and really high levels of virus in the blood often does happen during acute infection bit we occassionally see this also later on in some individuals well past acute stages of infection.

DW



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