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Desease progression
May 29, 2013

Dear doctor Young I went for the elisa test while having the acute infection with rash on my body at that time the follow up western blot shown undeterminate. I then took the pcr rna test and the result is 314000 copies per ml. The lab doctor concluded that i am infected. Two months later i did again the western blot and all returned positive, also the pcr rna is 224000 and my cd4 is 504. The doctor here in vietnam said i am still fine for a while and that i am newly infected which is true. Looking back at it, i actually knew exactly when i got exposed. From then to the point of cd 4 504 and viral load at 224000 is about 4 months. Is the viral load too high at this point? And does it indicate a very agressive progression? They said on average 8 years is the latency period what can be the case for me coz its way higer than the average viral load. My current situation does not allow me to commit treatment right away but if this is dangerous i would give up on things and monitor this closely. Your consultation would help me a lot in realising the urgency if it really is and make a sensible decision

Response from Dr. Young

Hello and thanks for posting from Vietnam.

You appear to have a higher than average viral load, but indeed, a significant minority of individuals do. While viral loads are higher during acute seroconversion, by 4 months, I'd expect your tests to be more representative of your chronic, or baseline level.

A higher viral load tends to predict more rapid loss of CD4 cells and higher risk of disease progression. Indeed, some experts argue that a VL >100,000 should be an indication for HIV treatment, independent of CD4 cell count.

With your current CD4 count in the normal range, your immediate risk is not great- and particularly with your inability to currently commit to being adherent to medications, waiting to start meds is not unreasonable.

Either way, monitoring your labs, especially the decline in your CD4s is highly recommended. In Vietnam (as in many parts of the world), treatment is recommended when counts go below 350. Here in the US, we'd simply recommend treatment.

I hope that helps, BY



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