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low Vl
Jan 15, 2004

Hi, I was diagnosed hiv+ oct 2002 with a vl 509, cd4 392, i started treatment same month, last blood work is vl undetectable , cd4 800. I am expecting another results 20/01/04. I am considering stopping treatment if I am at over 1000cd4s, because of the pressure treatment has put on my finances as Iam from a third world country.My questions are will my vl go back to just about 500 ,and what harm could vl of 509 have done to me without treatment,i must have been infected for three years without knowing, my wife of three years is still negative, I am currently on sustiva and combivir

Response from Dr. Lee

You mentioned that you are from a third world country, although you did not specify which one. As you may know there are different families (clades) of HIV which are predominent in different areas of the world. In the Northwest Hemisphere (US and Canada), Australia and Western Europe the Clade B virus is the most common type of HIV. Therefore in those parts of the world, the viral load tests mostly measure Clade B viruses and may miss or undercount viruses from other clades.

The practical application of this is that people who have non-B clades of HIV cannot rely on the viral load numbers which come from tests for Clade B viruses. The tests that are routinely used in the US for example undercount the non B clade viruses.

One of my patients who was infected in East Africa has always had a very low viral load (<1000)on the conventional tests. However, when we tested his blood for non B viruses, his viral load was actually more than 250,000.

If you were only infected for three years, as you explained, your viral load would likely have been greater than 509 to have affected your CD4 count to the 392 level.

In your situation, the viral load tests may not pick up the actual level of virus active in your system. If that is the case,treatment decisions may be more complicated. Ask your physician about the interpretation of your viral load in light of this clade issue.

Another issue related to the clade differences is the choice of combination therapy. The different clades may have different susceptibilities to the medicines, especially the protease enzyme inhibitors. Again, check with your doctor about the cross-clade activity of your medications.



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