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Why do I have no symptoms?
Mar 11, 2001

My husband had a rash that was then found out to be shingles. The doctor took a blood test and found that he was HIV positive. Since then he was supposed to have extremely high viral count and the CD4 count was extremely low. He was put on Combivir and Sustiva. He is undetectable now. My question is, he has never had any symptoms, except shingles and shows no signs of the virus, even when the doctor said he was extremely ill. He has been on the meds for over a year, no change. I am not positive (married 7 years) and my 3 children are negative as well. Is this normal? We ask ourselves all the time, does he really have it. Please explain this to me. I'm afraid to ask our current doctor. I don't want to offend her. Thank You Mrs. M

Response from Dr. Cohen

Part of the reason HIV has been so able to spread to so many is that it often causes no symptoms at all for years. And so, people feel well, and look well. And this allows someone who doesn't suspect they have HIV to continue to do things that other healthy people do - including have sex, and other things. Someone who meets them may have no suspicion at all that this person has HIV - there may not be any signs of it. And that observation is precisely one of the factors that allowed millions of infections. This is not true of all infectious diseases - some leave you feeling ill from day one, and you know you have something. Here, HIV may cause an initial illness, and then we recover. For years.

So - how is it possible to have a low CD4 count and still feel well? What is clear is that our immune system is built with "extra". Meaning that while we are designed to have an immune that has, on average, perhaps 800 CD4 cells in every cubic milliliter (a small drop) of blood - we can do well with far fewer. Now, some will have symptoms as the CD4 count drops. Early symptoms can develop - including things like shingles/zoster, and other minor infections. But, as the CD4 count continues to drop - the risk of other more serious infections increases. This doesn't always lead to a period of not feeling well as a warning - sometimes the first symptom is of a pneumonia - without much warning beforehand that something is wrong. Some will have warning symptoms like fatigue, weight loss, or something else. But others don't. We can't at this point easily explain why this happens, but it is clear that it does.

This is why there have been campaigns to encourage testing for HIV in anyone who suspects the chance for an exposure to it - since there may not be any symptoms at all. As Project Inform put it years ago - get tested or get sick - either way you'll find out.

Hope that clarifies. CC



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