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Viral Load of 400
May 29, 1997

Dear Dr.Gallant, I recently had protected intercourse with a woman who is potentially HIV positive. Unfortunately, there is no way for me to know for sure whether or not she is. I had a viral load test and an antibody test done approximately three and a half weeks after this event. The antibody test came back completely negative, as was to be expected. The viral load test, which was done on the same date, came back with a value of 400. This test was run on my specimen because I am a medical student, and being aware of the methodoligies, I requested additional testing. The result of this is that it has left me totally confused about where I stand now. Is this test too sensitive for an accurate diagnosis at this early stage? Does this test, due to its extreme sensitivity, often produce inaccurate results?

Response from Dr. Gallant

When a viral load test is done during acute HIV infection (the acute retroviral syndrome) you expect to see a very high number (several hundred thousand, for example). Low numbers (a few hundred to a few thousand) are unreliable and can represent a "false positive" result. While they should not be completely dismissed and should be followed up with additional tests, it would be a mistake to get to worked up about such a low number.

In your case I suspect that your result was completely negative. Are you sure that the result didn't say "less than 400 copies/mL," which is usually how undetectable results are reported? Since 400 is usually the lower limit of detectability, it would be strange that you would get a report of exactly 400, and much more likely that it is less than 400.

If I'm right and you were undetectable, then you should put this episode to rest. After all, it was a low-risk protected encounter.



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