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Risk of blooming with a resistant strain?
May 24, 2004

Dr., My numbers all point to being a long-term nonprogressor. My CD4 count ranges between between 560 and 900, depending on the time of day taken, which I have been told is unusual, and my CD8s range between 200-346. My percentages remain stable, 47-50% CD4s and 21% CD8s. My percentage is 2.18. My viral load has remained undetectable <50 with no blips. I have never been on meds, and have been fully positive for 8-9 months. What is the likelihood of my having to go on meds in the future? Am I likely to eventually bloom? I read that low viral replication rate could be an indication that I have a highly mutated protease inhibitor resistant strain, is that true? Have you ever seen that with somebody in my situation, when they changed to detectable? My doctors said that my low CD8 count is an indicator of very low replication, and possibly none, and that my body isnt detecting antigen. Im worried I might have a little bomb of virus that may go off at any time, and change my good luck. Does that happen with people in my situation often? Thanks, Worried in NYC

Response from Dr. Sherer

Unfortunately, the real number of long term non-progressors has been very low, <1% of all infections. On the other hand, there are many who have progressed very slowly, i.e. have not required therapy over a period of 10-15 years. Perhaps it would be wiser to set your hopes on a long period without treatment, which is very good news in and of itself, rather than setting your hopes too high.

It is still early in the known span of your infection to be sure, but I agree that you appear to have a very stable infection at this point. As there are many important sub-populations of CD8, I would not interpret high, low, or changing CD8 counts quite so simply. We are not aware of all of the causes for such changes, nor is it well established what their implications are for the natural history of HIV infection.

And, as you suggest, it may be that your virus is 'less fit', as an explanation for the level being below detection, but other explanations are also possible. If and when your virus level becomes detectable, you and your physician will perform a resistance test and partly answer that question.

Genotypic vs. phenotypic tests
COnfused re resistance tests - conflicting results

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