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Second posting, please please do respond - undetectable VL, non-M subtype virus strain? - resubmitted form the Fatigue and Anemia Forum
Apr 25, 2011

Dear Dr.Bob,

First of all, my deepest and sincerest gratitude to you for responding to my question earlier on Mar 28, 2011.

Further to your expert comments/ response, I had a detailed chat with my HIV specialist and he appreciated your response but further suggested that it may be another sub-type of HIV-1 virus rather than 'M sub-type' (as he is not convinced that the viral load can be undetectable 10 weeks from date of infection especially considering that the probability of someone being an elite controller from a developing country like India is highly highly unlikely as per him in his experience of treating over 1500-2000 HIV patients over last 6 -7 yrs). The RNA PCR Viral load test I have undertaken reads 'this test determines all known subtypes of HIV-1 subtype M virus'. My HIV specialist believes it can be sub-type N, O or P and unless we undertake special research tests in scientific lab, we cannot reply on the lab reports which suggest 'undetectable viral load'.

1. Do you think this suggestion is good to rule out any eventualities before taking a decision on periodic monitoring and treatment?

2. Do you think sub-type N, O or P is likely in my case as I read that these strains are very rare (< 1% of the HIV 1 & 2 infections). My exposure was to someone from Canada and I believe that person had been stable with only one partner from Canada over last 2-3 yrs.

Please help. God bless. (I think I can relax and WHOO-HOO a bit if I am eventually an elite controller - although this seems highly improbable - but it will give me a whole new perspective of life and people). Also, sometimes I feel it would have been better that my viral load showed some virus >48 copies so that I could have avoided the added agony of guessing whether it is HIV 2 (with an additional tridot test) or other sub-type of HIV 1 like N, O or P (now we have a task on our had to find a scientific research lab which actually does this test in my city from India!!).

Many thanks again. Appreciate and thank your time and efforts.

In distress after multiple HIV tests, Sincereguy

Response from Dr. Frascino

Hi,

1. I would advise periodic monitoring, whether or not you have additional diagnostic tests. As your HIV specialist advised, additional diagnostic evaluation would require "special research tests in a scientific lab". Such testing is generally used only for research purposes and consequently not well standardized. It can also be quite costly and difficult to interpret. You report your HIV exposure was Dec. 25, 2010. Consequently, if you are HIV infected, you've only been infected for 4 months at the most. Your immune counts are quite good. Waiting an additional period of time, 2 to 3 months, and then repeating your diagnostic workup (to rule out any remote possibility of lab or clerical errors) and your monitoring tests (quantitative HIV plasma RNA viral load and T-cell subsets) would be helpful and possibly revealing. I see no need to begin treatment until we have a better understanding of your baseline parameters.

2. It's possible but N, O and P are never likely, because they are all quite rare! They would be as unlikely in your case as they would in all other cases.

Good luck. Keep me posted as you proceed with your workup and/or routine laboratory monitoring.

Good luck.

Dr. Bob

http://www.thebody.com/Forums/AIDS/SafeSex/Q214270.html



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