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unclear results
Dec 10, 1999

I'm a 28 year old female who has recently tested positive for hiv (confirmed twice by the Western Blott test)but the time of infection is totally unknown (my sexual partners have tested negative, no blood transfusions or needle use). My viral load is undetectable (less than 20) and my CD4 is within normal range. No opportunistic diseases are present. I'm not starting medication yet. The next test in store is an hiv culture. My doctors seem baffled by my test results as well as my situation. Can you shed any light on this or direct me somehow? I don't know what to do or what to think.

Response from Dr. Pavia

You are in a very tough bind. The number of people who are infected who will have viral loads below 20 is very low, and if you really have been able to find all of your sexual partners (going back all the way) and none of them are positive, I wonder if you are really infected at all.

A few things to do, if not already done. One is to repeat the viral load with a bDNA assay, just in case you have a non subtype B virus, which might not be detected with PCR. Another is to talk with the state Health Dept and have them consider reviewing the western blots, doing the test in their lab, and perhaps checking for HIV2.

As for detecting virus in this situation, a standard culture is likely to be negative. What would be more useful would be a highly sensitive, CD8 depleted culture. This is the test that Bob Silicano and others used to show that the reservoir does not go away.

If all of the above are negative, I would bet you are not infected, but it must still be very hard to live with the uncertainty. Hang in there


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