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Newly diagnosed - seemingly inconsistent CD4 and viral load
Aug 25, 2013

Hello,

I am newly diagnosed (just 18 days ago) and have just began working with my doctor. I had tested negative several times in the past few years but just had a positive test last month, so we believe I have been infected in the past year.

My CD4 count became available from lab tests before my viral load and came in very low (177) so my doctor expected that my viral load would come in rather high (>1 million copies) because he suspected I was in the acute stage of infection. However, my viral load came in at about 75,000 copies so this questions that theory. I'm going to have another sample taken this week just before I begin ART, but I was wondering if you had any ideas on what may be causing my very low CD4 count, since we are fairly certain I am in the first year of infection. I have not had any of the typical symptoms associated with especially low CD4 counts; the positive test was performed during a physical exam during which my doctor told me I am in otherwise very good health. I also have not had any major illnesses in the past year consistent with what I've read about acute HIV. Just kind of a curious situation since I feel great but my CD4 count is low. I'd be interested in your thoughts on the situation.

Response from Dr. Holodniy

From your history, this looks like early HIV infection, but likely no longer in the acute phase. So the time when the HIV viral load was very high likely has passed and your viral load is now at the set point for your immune system. We certainly see people in your situation who are recently infected and with low CD4 counts. This may be partly due to the fact we don't know what people's CD4 count is before infection and your CD4 count could have been at the low end of the normal range to begin with. In addition, some virus strains are more aggressive in destroying CD4 cells than others and you could have become infected with one of those strains. Regardless, I would suggest getting a HIV resistance test to make sure what ever HIV meds you are started on are fully active against your virus strain.



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