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Concentrations of HIV in body fluids

May 19, 1998

According to AIDS books and research articles, there are enormous amount of hiv in body fluids(some millions per ml,to my memory) Dr.Sowadsky, what would be the REAL hiv concentration in the body fluids in the worset situation?(for example, in the acute retroviral stage and late stage of AIDS)

Response from Mr. Sowadsky

Hi. Thank you for your question. There is no such thing as a "Real" or "textbook" answer to this question. This is because the viral load can vary tremendously from one person to another. It could also vary from one stage of the disease to another (recent HIV infection, asymptomatic stage, full-blown disease, terminal stage, etc.), and it can even vary from one body fluid to another.

Viral load in blood:

Generally speaking, within the first few weeks after infection, the virus replicates rapidly, and the viral load may go to high levels. Soon afterwards, the immune system starts to control HIV, and the viral load drops significantly. As the years progress, the viral load may gradually increase, or it may increase rapidly. In the late stage of the disease, the viral load can be very high. At any stage of the disease, how high the viral load can go (and how low it can go) varies tremendously from person to person. The viral load can go as high as a million copies or more, or as low as "below detectable limits" (less than 25 copies on some tests) . If a person is on antiviral therapy, the viral load may decrease significantly, if the treatments are successful. Because the viral load in the blood can vary so much from one person to another, and because it can vary from one stage of the disease to another, a person with HIV/AIDS must be periodically tested to determine the amount of the virus in their blood. Even if the viral load is "below detectable levels", there is still a significant chance of transmission, if another person is exposed to the blood, semen, or vaginal secretions of a person with HIV.

Viral load in semen and vaginal secretions:

Generally speaking, the viral load in these body fluids roughly correlates with the viral load in the blood. In other words, when the viral load in the blood is high, the viral load in semen and vaginal secretions can also be high. And when the viral load in the blood is low, the viral load in semen and vaginal secretions can also be low. However, this is not always the case. For example, if a person has another STD like Chlamydia or Gonorrhea, the HIV viral load in semen (and possibly vaginal secretions) may increase, regardless of the viral load in the blood. During this time, the person may be more infectious to other people during sexual activity. The viral load in the semen would then decrease after the STD is successfully treated.

Viral load in saliva, tears, sweat, and urine:

Regardless of viral load in the blood and other body fluids, the viral load in saliva, tears, sweat, and urine is normally extremely low at all times (or may not be found at all). At any stage of the disease, these body fluids would only be risky if they contained visible blood.

In summary, there is a lot of variability in the viral load. This is why we depend so much on viral load testing to determine how well a person is doing clinically. So the answer to your question is highly variable, depending on the person, the stage of the disease, how well they are responding to antiviral therapy, and which body fluids you are talking about.

If you have any further questions, please feel free to call the Centers for Disease Control at 1.800.232.4636 (Nationwide).

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