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VL detectable after 2 1/2 yrs
Apr 24, 2000

Dr. H.

I was diagnosed HIV+ approximately 2 1/2 years ago. I had had 2 NEG antibody tests 6months and 1 year prior to the POS. I believe I caught my infection very early on as my VL was 450,000 and CD4/CD8 was 500/550 and . I have been on Viramune, 3TC, D4T since diagnosis. My VL went to <20 within 8 weeks, and my CD4/CD8 went to 1050/560. I have not had any side effects or major problems with medications except for moderate trigylcerides 400+ (cholesterol is 140)and very low range testosterone. My CD4/CD8 count has remained in the 1000+/500+ range ever since and my VL has always been <20. Jan 2000, my VL came back as 34 CD4/CD8 was 1024/540. Initially my Dr. and I discounted VL due to useage of Prednisode dose pack 5 weeks prior to blood draw for severe sinus allergies/inflammation. BUT.. April 2000 my VL was 45 and CD4/CD8 1049/553. Immediately I was thinking this is a trend, perhaps the emergence of resistance? Coincidently in April, I had an Extended Lymphocyte Panel done. Condensed results as follows:

Total T cells 1605 mm3

Total Activated T Cells 12

Total Helper Cells 1049

Total Suppressor Cells 553

Total B Cells 232

t.CD8+/CD57+ 235 mm3

total CD57+/CD- cells 245

total NK cells 105

total CD8+/CD38+ cells 128

total CD8+/CD11b+ cells 16

helper/suppressor ratio 1.90

My Dr. agreed to perform a phenotype test to see how well the virus grows in the presence of my meds to see if any one of them is less effective than the others. She indicated that Genotype testing was ineffective when VL <1000. Should I not be concerned as long as my VL is <50? Could I STILL be experiencing VL rebound effect from Prednisone useage. Prednisode was for 7 days, decreasing dosage from 40mg to 5 i believe.. standard dose pack. I have a follow up appt in 1 month to get phenotype results back. Any input would be greatly appreciated. Thanks again for all you work in this forum, it is a great source of information. Mike

Response from Dr. Holodniy

I will be curious to see whether a phenotype test can be performed. It has many of the same sensitivity issues as genotyping. It is also interesting that you are getting results reported below the 50 copy threshold. The reliability of copy number below 50 is not that good. A change from MH

no viral load, no condoms?
Possible resistance?

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