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Viral loads in other body fluids
Jul 25, 2004

Your discussion of very, very rare cases of infected folks repeatedly testing negative is most interesting.

My question is this: is it true that HIV levels are usually higher in sperm than in blood? If so, have some of those rare cases been diagnosed by doing a DNA PCR and/or ELISA on sperm and/or cells in the mouth...establishing infection that way when PCR's and ELISA's on cells/blood have been negative despite a clinical picture that suggests HIV?

Thank you.

Response from Dr. Conway

Numerically, the amount of HIV that is present may vary from one reservoir to the other. It will tend to be the highest in the plasma or in the circulating cells that turn over the most rapidly (usually CD4 positive lymphocytes).

There are rare cases where the most virus was isolated from the brain, the virus presumably replicating in an area where it was beyond the control of the immune system.

As far as semen in concerned, the virus is either in the seminal fluid or in the inflammatory cells that are contained in the ejaculate. Generally, the more cells there are (as in the case of a person who has another STD, such as gonorrhea or chlamydia), the more virus there will be. It may also be that the seminal fluid represents a protected reservoir that can accumulate virus more than in the blood. However, I am not aware of any cases where an individual was only diagnosed by the presence of virus in the seminal fluid or sperm, and had no virus present anywhere else, and ahd not detectable anti-HIV antibodies in the blood.



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