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VL Discrepancy

Jul 4, 2009

Hi Doc...something is troubling me big time! My girlfriend tested + about 6 months ago with a VL of over 700K and CD4 count of almost zero. Immediately I tested upon getting her news and discovered I too was + but my VL was only 7K and my CD4 count was something like 300. Needless to say, this came as quite a shock to me as she has sworn up and down that there has been no infidelity on her part (mine either for that matter but this thing had to come from somewhere). My question is then that in knowing that every individual's body make up is different and if she in fact infected me, why such a huge gap in VL given that what I've read on this thing, the info seems to indicate that the VL tends to be very high when initially infected? Her specialist seems to think she could have been infected for quite some time (5-10 years she says) given her low CD4 count. We've been together for the last 7 years and had been having sex very regularly and I've been the picture of health with normal health screeningsand now I show up positive? I think I read somewhere too where the VL is initially high and then it reaches a "set point". What exactly does this mean and can you give any ideas as to how these issues can be explained? As always, thanks for your time Doctor RJ!

Response from Dr. Frascino


I agree with your girlfriend's HIV specialist. Your girlfriend most likely has been infected for a very long time (7-10 years). If you've been together only seven years, this could be one reason her condition is more advanced than yours. Also, everyone responds to HIV a bit differently based on their individual immune system response to infection. In other words not everyone has the identical clinical course, even thought they may have acquired the same viral strain.

The viral set point is a point of equilibrium at which one's immune system holds HIV viral replication temporarily in check at a certain level. Over time, however, the virus wins out over the body's immune response. CD4 cells get destroyed and then the HIV plasma viral load once again increases to very high levels. You can read much more about the natural history of HIV disease in the archives. Both you and your girlfriend would benefit from becoming more informed about HIV and its treatment. Begin with the section titled "HIV Basics" that can be accessed on The Body's homepage.

Good luck to you both. I'm here if you need me.

Dr. Bob


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