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"Undetectable" questions
Mar 4, 2004

Dr. Sherer, Three questions: 1)Under successful HAART with normal range CD4+ and non-detect VL, is the virus still active and replicating albeit at a very low level or is it just hanging out in reservoirs waiting for release into the peripheral system? 2)If you get a cold or other infection while on successful HAART (VL not detected) does this spike your VL because your immune system is more active? 3)With successful HAART have research labs been able to use "research" methods to see how low VL can go? Recently infected and on meds 12wks w/excellent results. Thanks!

Response from Dr. Sherer

That's three good questions. #1. Yes, the virus is still replicating at a low level, both in the blood and in reservoirs such as the CNS and the gonads. #2. Yes, activation of the immune system for a variety of reasons, eg viral infection or vaccination, can cause a transient rise in the viral load in the blood. There appear to be several mechanisms for that. #3. Yes, viral load assays that measure VL as low as 3 copies per ml have been developed. And even in people with VL below that level, evidence of continuing replication has been found.

So this story gets complicated. On the other hand, the important larger issues are known. If you are able to keep up with the best possible adherence to your medications, you have given yourself the best possible chance to remain below detection, to have the highest possible rise in your T cells, and the longest possible durability of this current regimen.

So, study the disease as much as you like...but don't try to take your doctor's place, and don't forget the clear and simple facts of HIV infection.


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