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Food for thought...mild HIV ?
Jun 6, 2001

Dear Dr Little,

I have read (on this forum) of so many people (calling themselves worried wells) who have had possible exposures to the HI virus, developed the range of symptoms but have repeatedly tested negative. Is it quite possible that these people ARE actually being infected but with with a 'mild' form of the HI virus (and hence their symptoms) which eventually 'dies' (much like the 'flu virus) before having a chance to develop into the more potent HI virus ? Do you think that this "mildness" of the HI virus is the result of the milder viral load of the person from whom they contracted the virus ? I guess what I am getting at is that someone can become infected with HIV (and still test negative) but because of the low-level infection (perhaps due to potency of viral load) does not develop HIV antibodies (i.e. they are effectively HIV negative). Please respond as I would love to read your thoughts on this. Many thanks !

Sachin Durban, South Africa.

Response from Dr. Little

I will have to disagree. I believe that all people that become infected with HIV do test positive by HIV1/2 antibody testing over time. There is some data that people who are repeatedly exposed and yet do not become infected will develop some test results consistent with exposure - but these people test HIV negative and ARE negative. There are some circumstances where the development of an HIV antibody test may be delayed (i.e., in someone who takes antiretroviral therapy immediately following exposure and infection), but these people will all ultimately test positive. The concern about very rare strains of HIV (N and O types) are not very signifiant in North America (yet) and as such the risk that standard antibody testing will miss infection by one of these more rare forms is still extremely small. Some people may control their viral infection VERY effectively, but they all develop antibodies. I can only imagine that there might be an exception in someone with a severe immunological disorder (from birth typically) which makes them unable to form certain types of antibodies - this person might not mount a typical response, but then these people are generally already in medical care for their pre-exisitng immunological disorder and different types of HIV testing could be perfomed to rule out infection.


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