I found out that I was poz during an admission for PCP in 12/03. At that time, I had two T-cells (Frick and Frack) and my viral load was under 500. I've been taking meds since that admission and my viral load has always been under 500 or undectable (<50). My t-cells two weeks after leaving the hospital were 179 and since have dropped. The Tcells have risen from time to time but I never reached 179 again. Recently, within a two month period my T-cells have gone from 150 to 105 to 64. During these last two years my CD4% has many been 8% or 9%. With the recent test where my T-cells dropped to 64 my CD4% went up to 13%, which is the highest it's ever been. Another non-MD forum said I'm probally in a very advanced stage of AIDS. I don't understand what's going on. One thing I did want to mention is that I have been under a great deal amount of stress for the last three months. To be honest it's the most stress I ever had to deal with. A lot of it had to do with Medicare part D. I hope this makes sense.

Thank you for your posting.

There are certain parts of what you describe that are a little hard to understand and others that I think I may be able to shed some light upon.

The fact that your viral load has been undetectable since the very first test when you had PCP and two T cells is unusual. At this point a repeatedly negative test may be related to good antiretroviral therapy but this would not explain the initial results. Assuming your standard HIV antibody test is positive, which I am sure based upon what you write, the most likely explanations for this is that the virus you have is for some reason not detected by the viral load test being performed. This most often occurs in people who either don't have HIV-1, but rather have HIV-2, or have an uncommon type of HIV-1 that is just not detected by the assay used. HIV-2 is mostly found in Western Africa with occasional cases identified around the world. If you had HIV-2 I would not expect your HIV-1 Western blot to be fully positive. If upon review of your antibody test it is found that your Western blot was not complete you could confirm an HIV-2 diagnosis by ordering a HIV-2 Western blot.

In the current era viral load assays are much less likely to miss the different subtypes of HIV-1 since they have been developed to detect many of these other strains. It may be worth repeating your viral load with whichever assay has not been used in the past, usually either Roche RT-PCR or Bayer bDNA. If you find that another test results in detectable viral loads then you would want to stick with that test and be treated accordingly.

The CD4 response is somewhat easier to explain. We have known for some time that absolute numbers fluctuate routinely while the percent generally remains stable. The clinical relevance of this type of fluctuation is not clear and generally I reassure patients that as long as their viral load is undetectable and the CD4 cells are not trending downward over time I believe they will be fine. At this point I would recommend that you discuss this with your provider and come up with a plan. It would be reasonable to stay on your current antiretroviral therapy or to switch to an alternative regimen with close follow-up simply to see if it makes a difference. Regardless, as long as your viral load is not detectable with an alternative assay you are likely to do well but shoule remain on whatever treatment you are on to prevent recurrence of PCP infection. I would also suggest that you continue good follow-up with your provider and do whatever you can to reduce stress and to take care of your self by maintaining a good diet and as much regular exercise as is appropriate.

Best, Eric