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Author Topic: recently diagnosed--interpreting (the strange) test results...  (Read 5299 times)

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Offline surprised

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About two months ago, I received my initial hiv-positive diagnosis, despite being vigilant with safe-sex.  Since then, I've had three sets of tests done, with rather odd results.  They were:

1st test:  CD4:  300 (20%), viral load:  2,100
2nd test:  CD4:  695 (33%), viral load:  300
3rd test:  CD4:  770 (30%), viral load:  400

The tests were each taken about three weeks apart, and I'm not on any drug regimen and haven't done anything differently.  Reading through the many posts on this forum, it seems that my results are atypical--especially pre-HAART.  The ID specialist whom I'm seeing is also puzzled.  He thinks that the initial test might have been incorrect--given the dramatic variances in the CD4 (and %) numbers--but he's not sure. 

Has anyone seen similar progressions/patterns before?  How would you interpret these results?  The viral load figures seem low--are they too low to seriously consider the various drug regimens?  I would be very interested in your thoughts and feedback...


Offline Central79

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Re: recently diagnosed--interpreting (the strange) test results...
« Reply #1 on: March 25, 2007, 12:09:40 PM »
Hey Surprised

Welcome to the forums, I'm sorry to hear about your diagnosis.

Your numbers are indeed interesting. It's quite common to see a rebound in the CD4 number and the CD4 % after seroconversion, when viral load is typically high. That fact that you're CD4% has changed so much indicates that the first lower numbers are due to HIV.

But as you say, your VLs are low, and may never have been that high. I have a friend who had a similar pattern and is shaping up to be a long-term non progressor - he can just control it w/o drugs for the moment and has a very low VL and a very good CD4 count.

Definitely agree it's worth you testing again, but I wouldn't hold your breath as the tests are very accurate. Personally, I wouldn't consider going on drugs with a CD4 of 770 that's heading in a very good direction. I'd see where it tops off and see where the VL is at and then make a decision. You have to look at trends, and not get too hung up on an individual set of numbers. There's no proven benefit yet of starting meds earlier than 350, although there's lots of talk about it right now.

All the best,

Diagnosed January 2006
26/1/06 - 860 (22%), VL > 500,000
24/4/06 - 820 (24.6%), VL 158,000
13/7/06 - 840 (22%), VL 268,000
1/11/06 - 680 (21%), VL 93,100
29/1/07 - 1,020 (27.5%), VL 46,500
15/5/07 - 1,140 (22.8%), VL not done.
13/10/07 - 759 (23.2%), VL 170,000
6/11/07 - 630 (25%), VL 19,324
14/1/08 - 650 (21%), VL 16,192
15/4/08 - 590 (21%), VL 40, 832

Offline Just_Need_A_Pain_Killer

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Re: recently diagnosed--interpreting (the strange) test results...
« Reply #2 on: March 25, 2007, 12:29:05 PM »
wow.. well first, the test themselves have a pretty steep margin of error.. but not THAT much.. I went from 16 ts to 150 in 4 weeks, but that was at the start of my first regimen.. your viral load is VERY low.. 700 ts can actually be considered a normal level.. typical range is around 600 to 1100.. give or take.. depending on who you talk to.. its hard to guage the ts unless you know a specific date of infection.. could be your immune system has had a chance to respond aggressively to the virus, but it seems like ts were kind of low initially for a brand new infection.. vaaries from person to person.. lots of factors could have been in play and Im certainly no doctor.. Id be having a beer  ::) and thanking that gift horse right about now..

Offline otherplaces

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Re: recently diagnosed--interpreting (the strange) test results...
« Reply #3 on: March 27, 2007, 07:05:01 PM »

Not everyone responds in what is considered a 'normal' way to HIV infection.  My numbers bounced all around and then hopped back up to my first CD4 test, and then just crashed.  I would be very pleased with the numbers you have...they're very excellent.  And yes, the low VL could indicate that you are indeed a 'long term non-progressor'...only time will tell.  I know it must feel like quite a mixed blessing considering what this good news is about, but you will adjust and I'm sure you have a long bright future ahead :D

Best of luck and much love,

Offline milker

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Re: recently diagnosed--interpreting (the strange) test results...
« Reply #4 on: March 27, 2007, 07:10:50 PM »
Surprised, do you have an idea of when you might have been infected?

When is your next test due? 3 weeks is a short time between tests with those results, but they look fantastic!

mid-dec: stupid ass
mid-jan: seroconversion
mid-feb: poz
mar 07: cd4 432 (35%) vl 54000
may 07: cd4 399 (28%) vl 27760
jul 07: cd4 403 (26%) vl 99241
oct 07: cd4 353 (24%) vl 29993
jan 08: cd4 332 (26%) vl 33308
mar 08: cd4 392 (23%) vl 75548
jun 08: cd4 325 (27%) vl 45880
oct 08: cd4 197 (20%) vl 154000 <== aids diagnosis
nov 2 08 start Atripla
nov 30 08: cd4 478 (23%) vl 1880 !!!!!!!!!!!!!!!!!!!!!!!!!!
feb 19 09: cd4 398 (24%) vl 430 getting there!
apr 23 09: cd4 604 (29%) vl 50 woohoo :D :D
jul 30 09: cd4 512 (29%) vl undetectable :D :D
may 27 10: cd4 655 (32%) vl undetectable :D :D

Now accepting applications from blowjob ninjas™

Offline megasept

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  • Steven here...
Re: recently diagnosed--interpreting (the strange) test results...
« Reply #5 on: March 28, 2007, 12:53:26 AM »

1st test:  CD4:  300 (20%), viral load:  2,100
2nd test:  CD4:  695 (33%), viral load:  300
3rd test:  CD4:  770 (30%), viral load:  400

Hi. Assuming you used the same lab, I think the results are real. The relationship between the cd4s and VL are correct. They should, and do, have a tendency to go in inverse directions. I agree with Milker who suspects you might have a fairly recent sero-conversion. HAART or any treatment is not the question here. Bigger curves and trends (along with inconsequential fluctuations) are common without any treatment (whether "naive" or on a long term STI, like me).

Your questioning is reasonable. These are great #s and show a wonderful trend in your favor. Your own immune system is working. Enjoy!  8)  -megasept

Offline surprised

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Re: recently diagnosed--interpreting (the strange) test results...
« Reply #6 on: March 28, 2007, 02:39:09 PM »
Thank you, Matt, Will, Brian, Milker, and Megasept for sharing your experiences, expertise, and encouragements--I really appreciate it.

I realize that given the diagnosis, these are good results--and I'm very thankful about that.  I met with my doctor again this week, and he revealed that the genotypic assay results came back inconclusive.  The lab wasn't able to perform the tests as it required a viral load of at least 1,000.

The first test was performed in a different lab, whereas the last two were from the same.  Hence, my doctor raised the question of whether there might be lab-specific issues or errors.  The reactive western blot test was also performed by the first lab.  To be honest, I'm not sure when the sero-conversion could have occurred.  My last test was performed about a year and a half ago, so it could have happened from 3 to 21 months ago.  What surprised me was that I've not had unprotected sex and have erred on the safe side.  But as they say, there's still risk in low-risk activities.

When the first results came back, I was deemed not to be a recent sero-convert--largely based on the low viral load number.  But with the results of the other two tests (and assuming that the first test was correct), the possibility of recent sero-conversion came back.  My next test hasn't been scheduled, but will likely be in late April or sometime in May.

I spent quite some time with my doctor to run through the different options.  The easiest path is to monitor and wait.  But there seem to be suggestions that early treatment while CD4 counts are high (and if one is adherent) can be of benefit--especially for avoiding the potential depletion of CD4 reserve in specific organs.  The flip side is the potential for various side effects of long-term treatment--such as lipodystrophy.  I'm very much in the learning mode on this, and am trying to research and digest what the online resources (like Poz, Aidsmeds, CDC, PubMed abstracts) have on the topic.  One question at this point is whether there's benefit to launch a treatment assault (assuming that it's a recent sero-conversion), or whether the window has already passed.  My doctor's thought is that once treatment begins, one should continue without break.

Offline otherplaces

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Re: recently diagnosed--interpreting (the strange) test results...
« Reply #7 on: March 28, 2007, 11:25:08 PM »

The evidence that starting treatment early is beneficial is mixed at best.  I was also faced with this decision as my doctor offered to enroll me in the SMART study which studied treatment interruptions.  If I enrolled I'd be randomly put into either a treatment arm of the study or the wait arm of the study.  Being random I wouldn't know ahead ahead of time.  The pro being that my lab tests would all be paid for, the con being that if I ended up in the treatment arm I'd have to start treatment right away.  So I had to look at all the evidence to see if I thought starting treatment right away would be okay for me.  At the time (year and a half ago) I just didn't see enough evidence to convince me it was worth it versus the side effects of meds.  I guess it all ended up being a wash for me as a year after infection I had to start meds anyway.  The side effects for me have been almost nil, but it's the long term side effects that I still worry about and I think is worth taking into consideration.  Because if you do turn out to be a LTNP you could possibly wait many years before you start meds.  The argument to start treatment early is that it could limit the latent infection in the body, but they don't know this for sure.  I'd suggest you sit down, dig in, and read the articles for yourself and see how you feel after thinking about it a good bit.  There's no rush to make a decision right away.

I wish you the best,


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