HI , I TESTED POSATIVE IN OCTOBER '97 , THE INITIAL CD4 COUNT WAS 756 AND THE VIRUL LOAD WAS UNDETECTEBLE. THE NEXT TESTS WERE DONE SIX MONTHS LATER AND THE CD4 COUNT WAS 2200 AND THE VIRUL LOAD WAS STILL UNDETECTABLE ,THE RECENT TESTS THAT I HAVE HAD AGAIN SIX MONTHS LATER SHOWED THAT THE CD4 COUNT WAS ABOUT 1020 AND THE VIRUL LOAD WAS NOW DETECTABLE AT ABOUT 778. MY DOCTOR THINKS THAT THERE IS STILL NO NEED TO GO ON MEDICATION , BUT I AM REALLY NOT SURE ABOUT THAT . I WOULD REALLY LIKE TO KNOW IF THESE RESULTS MEAN THAT THE VIRUS IS NOW PROGRESSING AND IF SO SHOULD I BEGIN MEDICATION ???

Well, first - it is truly a statement about the power of the net that we can tie people together - from Zambia to the States - and share our knowledge across borders.

So - how to interpret the viral load numbers - over the past ten years we have monitored viral load and which levels are associated with any damage in the CD4 counts. And the group with the least damage is those with a viral load that remains below a few thousand. So for you - all of the results you mention suggest there is little cause to expect any CD4 count decline - even without treatment. Now - the viral load can bounce around a bit - by even as much as two or three times - and still not represent a true change in you. Meaning you could have a test result of "undetectable" - but that just means that it is below the ability of THAT TEST to measure it. So - if we assume you had a true result of 350 - by the usual tests this is reported as undetectable - but should be better called BELOW detectable (since the two most common tests have limits of measurement of around 400-500 copies.) But given the normal 'bounce' we see in the viral load - a value of 350 can bounce up to around 1000 and still bounce back down. Without any real change in your viral levels. And this range of viral loads is associated with the slowest rate of damage - in fact some with your counts will have stable CD4 counts without treatment for years and years... and therefore it is uncertain if antivirals are needed in this case.

The same bouncing around is seen in the CD4 count - altho the size of the bounce tends to be even bigger. And the counts you report all sound more similar than different - and all are good.

But continued monitoring - every 3-6 months - is the key. While the values you report are all reasonable to sit with - we can't always to sure the next value in the viral load will bounce back down. Fortunately - even a viral load of a few thousand higher is not an emergency - the rate of damage done is slow enough so that you have time to review the results and make a plan.

Also - You don't mention which test kit you are using, and different tests can have different values. In fact - you should check to be sure that the tests you had done were all using the same test kit - since they can differ and that alone might explain the different values you report. AND - some tests are better able to report the different strains of HIV that are more common in Africa than elsewhere - so be sure your clinician is using the right test for you.

In sum - it sounds like all is stable - and the advice you are getting is reasonable.

Hope that helps. CC