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devastating acute phase/low VL
Jun 17, 2007

I was diagnosed in the acute phase of my infection. I had my first blood draw when I was still experiencing extreme fatigue, sore throat, glands like golf balls in my neck and underarms. I was undetectable to 400 ppml so the Dr ordered a second test to confirm the results since they were surprising given the circumstances. 2 weeks after that initial blood draw I was pretty much symptom free except for the extreme emotional distress my diagnosis triggered(finally that's passing. Honestly, after having been so sick i was really shaken up by hearing i was doing so well. It was not what i had steeled myself to hear and through me a little. The second test came back 464ppml and she asked if I minded having a third blood draw more out of curiosity than need. I was all for it. I believe knowledge is power. The last test was 214ppml. All my CD4s and percentages have been well within the normal range. My question is based on my curiosity. Is there any data on VL spikes in people that later control the virus well as I evidently have over at least over a three month period? Is their documentation that people whose bodies control their viral load ever experience any real Viral load spike during the acute infection? my acute phase was far worse than what I read is normal and lasting 6-8 weeks and causing me to miss 20 plus days of work due to the fatigue. My Dr. hyposthisised it might of had to do with my response. It made sense to me as an answer to why I was so sick for so long but, I am curious if there are any case studies comparing the acute infection VL of people who develop control over their VL w/o meds post acute phase. I know today's numbers don't mean tomorrows' wont be 5 log bigger or I won't get hit by a piece of a satellite crossing the street tonight but, am curious as to what is known about the acute phase in people who later control the virus well. If my set point is 214ppml might my acute infection stage of consisted of a ten fold spike to say 2000ppml rather than 200000 ppml? The more I read it seems the less seems known =/ about Hiv infections/responses sometimes.

Response from Dr. Pierone

Hello, and thanks for posting.

Your doctor's hypothesis makes sense to me too and fits with the notion that a robust initial immune response might translate into severe early symptoms, but favorable long-term immune control of viral replication.

There are some data on long-term follow-up on people with initially present with low-level viral levels (but not necessarily acute infection) and the news is good. If there is good immunological control of HIV infection, as in your case, this positive control tends to persist over the course of years. Our team has been following a handful of patients with viral load levels between 50 and 1000 for over 10 years and these individuals have remained well with no evidence of viral rebound or immunologic decline. However, life is unpredictable, and one such patient was hit by an asteroid fragment while sitting in his living room. Luckily it was a glancing blow and most of the damage was to his flat screen TV.

Let us know how things turn out and best of luck!



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