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Responding to Dr. Wohl
Dec 8, 2002

Dr. Wohl,

Recent HIV + here, replying back to you. My region is the Eastern U.S., I work in an inner city hospital er, my test I believe was the Western blot, which divides up into like 10 different things and I was positive for all, my viral load and my CD4 count was done and my doctor was very confused too, he said they were completely normal, as if I didn't really have HIV. I have had 3 different antibody screenings and they were all positive. I have no other illnesses what so ever, I have never had any signs or symptoms, except for fatigue, but I am also 100lbs overweight, which we are working on. I just want to know my outcome. My husband is negative, my daughter we don't know. I didn't have an HIV test prior to my pregancy, but my husband and I had unprotected sex my whole pregnancy and without detail, he had my breast milk, and I had a c-section, so I'm hoping my daughter is ok. This site is great! You guys are doing a great thing! Any help is appreciated.

Response from Dr. Wohl

Thanks for providing the added information. I have copied your original question and my reply to you below so those who read this post know what we are talking about. That your antibody ELISA and western blot are both repeatedly positive and that you apparently responded with multiple positive bands on your western blot indicates to me that you are indeed HIV infected.

As I replied earlier, your undetectable viral load is rare but happens. I have several HIV-infected patients who I work with who have never had detectable HIV viral loads and have stable and normal CD4 cell counts for YEARS. It is estimated that about 5% of all HIV infected people are such long-term non-progressors.

I would make sure that the viral load test you had done picks up most non-clade B viruses. It might not hurt for your clinician to talk with your lab to see what test was done and whether other tests for very rare clades (strains) your first test may miss can be done. Likewise, your doc can try to get your blood tested with viral load assays that have a lower limit of detection even lower than the standard 50 copies/mL. Such tests are used for HIV clinical research purposes and a well placed call to a university hospital contact should work under such circumstances.

(While certainly not fool-proof, I often look to see what the total protein level is in the blood of a patient with a question about whether they are HIV+. In HIV, lots of antibodies are produced for a number of reasons. This leads to an increase in total protein - a test that is easily measured. It is not diagnostic but if present provides further support for HIV being present.)

Just curious, were you diagnosed perinatally? Any occupational exposures such as a needle stick, splash or prolonged contact with blood or other body fluids? DW

QUESTION I recently HIV+, my husband is negative, my daughter I don't know yet. I feel like my life has been turned upside down. I have no signs or symptoms, my doctor ran the other test CD4 and Viral load, and they were completely normal, he didn't even think that my HIV test was mine, because of that, so I had a second one done and it was + too. What does all this mean for me, and my family, what does the CD4 and viral load test mean. I have no idea when I was infected, as I am with HIV+ people everyday in my line of work. Help me please.

RESPONSE Hi-

I will try to help but the situation you describe is somewhat unusual. So, I will need a bit more information. Can you tell us what region of the world you live in and what kind of work it is you do? Also, was your HIV viral load test "undetectable"? Do you know what HIV test(s) you had that was positive? Do you have any other illnesses?

I ask this to make certain I understand your circumstance. There certainly are individuals who are HIV-infected as demonstrated by repeat HIV antibody testing using an ELISA and confirmatory western blot test but who do not have detectable HIV viral loads on routine testing.

Most, if not all, of these people are the so-called 'long-term non-progressors' - people who have HIV but do not experience the decline in T-cells that is the hall mark of HIV infection. But, a key issue is to make sure the viral load test is able to detect the virus that is infecting an individual. Some of the viral load tests can have difficulty picking up certain strains of HIV. This is why geography is important as all the viral load tests detect clade B virus which predominates in my part of the planet. Send back more information and I will see what help I can be. DW



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