Aa
Teak and Chris
What actually causes a HIV positive person's viral load to be undetectable <48 copies? In other words, the literature states that the virus enters the body, multiplies fairly quickly over days and certainly over the first couple-few weeks. Then your body reacts by producing antibodies. It is my understanding that antibodies are created to fight the HIV virus just like antibodies that are produced to fight everyday bugs. I guess the difference with HIV is it continues to thrive in the body.
The reason I ask is because I know there is a lot of discussion around undetectable viral loads. Clearly it is possible for someone to have an undetecable viral load and still have HIV. However, if this is the case, would it make sense that their body would have produced detectable antibodies to squash the virus to undetectable levels? If this isn't the case, then what does control the virus so well in some people that makes it undetectable? By the way, I'm referring to acute hiv or early stages. I understand the medical therapies to treat HIV can also help reduce the viral load. I'm just not sure how someone could have an undetectable viral load when they are symptomatic after a couple weeks-2 mos post exposure. How does a HIV pos person know if they didn't ever have a detectable viral load if their viral load in undetectable today. It may have been high early on right?
Also, I know these tests are techinically not diagnostic tests. Teak, I know you aren't a big fan for this reason. Clearly there is some risk of false pos because the test is so sensitive and specificity is not 100% and the cost is high. It just seems like there aren't many or any documented cases of false neg during acute hiv...maybe I'm wrong but I can't seem to find anything.
The reason I ask is because I know there is a lot of discussion around undetectable viral loads. Clearly it is possible for someone to have an undetecable viral load and still have HIV. However, if this is the case, would it make sense that their body would have produced detectable antibodies to squash the virus to undetectable levels? If this isn't the case, then what does control the virus so well in some people that makes it undetectable? By the way, I'm referring to acute hiv or early stages. I understand the medical therapies to treat HIV can also help reduce the viral load. I'm just not sure how someone could have an undetectable viral load when they are symptomatic after a couple weeks-2 mos post exposure. How does a HIV pos person know if they didn't ever have a detectable viral load if their viral load in undetectable today. It may have been high early on right?
Also, I know these tests are techinically not diagnostic tests. Teak, I know you aren't a big fan for this reason. Clearly there is some risk of false pos because the test is so sensitive and specificity is not 100% and the cost is high. It just seems like there aren't many or any documented cases of false neg during acute hiv...maybe I'm wrong but I can't seem to find anything.
Detection of HIV-1 infection in blood donors during the immunological window period using the nucleic acid-amplification technology.
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Key journal articles ranked for newsworthiness and clinical relevance in each specialty, linked to Medline abstracts.
Transfus Med. 2007; 17(3):200-4 (ISSN: 0958-7578)
Scuracchio PS; Poli MC; Lemos MM; Oliveira Filho AG; Salles NA; Chamone DA; Magri M; Cavalcante NJ; Collela R
Banco de Sangue de São Paulo, São Paulo, Brazil. ***@****
Individual nucleic acid-amplification testing (NAT) was recently recommended by Brazilian legislation and has been implemented at some blood banks in the city of São Paulo, Brazil, in an attempt to reduce the transfusion transmission of human immunodeficiency virus (HIV) and hepatitis C viruses. This screening test can identify donations made during the immunological window period before seroconversion. The impact of this technology in our blood donors and transfusion routine was studied. In all, 47 866 donations were tested from March 2004 until November 2005, according to Brazilian legislation, using two approved enzyme immunoassays for HIV antibodies and individual NAT. Supplemental tests included Western blot, p24 antigen detection and quantitative PCR-HIV-1. Among the donors screened, two (one first-time and one repeat donor) were non-reactive in enzyme immunoassays, with negative confirmatory p24 antigen and Western blot, but positive for HIV-1 NAT. Although serological analysis for HIV is a primary tool for diagnostic testing, the addition of NAT allowed for identification and prevention of component transfusion from two HIV-positive blood donations during an 18-month period. The screening of donors reduced the immunological window period, permitting the identification of very early stage HIV infections. In addition, this report also emphasized the fact that the risk of HIV transmission is not limited to the first-time donors.
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Medscape Best Evidence
Key journal articles ranked for newsworthiness and clinical relevance in each specialty, linked to Medline abstracts.
Transfus Med. 2007; 17(3):200-4 (ISSN: 0958-7578)
Scuracchio PS; Poli MC; Lemos MM; Oliveira Filho AG; Salles NA; Chamone DA; Magri M; Cavalcante NJ; Collela R
Banco de Sangue de São Paulo, São Paulo, Brazil. ***@****
Individual nucleic acid-amplification testing (NAT) was recently recommended by Brazilian legislation and has been implemented at some blood banks in the city of São Paulo, Brazil, in an attempt to reduce the transfusion transmission of human immunodeficiency virus (HIV) and hepatitis C viruses. This screening test can identify donations made during the immunological window period before seroconversion. The impact of this technology in our blood donors and transfusion routine was studied. In all, 47 866 donations were tested from March 2004 until November 2005, according to Brazilian legislation, using two approved enzyme immunoassays for HIV antibodies and individual NAT. Supplemental tests included Western blot, p24 antigen detection and quantitative PCR-HIV-1. Among the donors screened, two (one first-time and one repeat donor) were non-reactive in enzyme immunoassays, with negative confirmatory p24 antigen and Western blot, but positive for HIV-1 NAT. Although serological analysis for HIV is a primary tool for diagnostic testing, the addition of NAT allowed for identification and prevention of component transfusion from two HIV-positive blood donations during an 18-month period. The screening of donors reduced the immunological window period, permitting the identification of very early stage HIV infections. In addition, this report also emphasized the fact that the risk of HIV transmission is not limited to the first-time donors.
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I did actually speak with someone after this incident initially happened and I got back a neg VL test at 2 wks...my doc said I neeeded to chill a little. At that time, the lady I spoke to discussed that I clearly have OCD...no kidding. She said stop replaying everything so much. Well that is easier said than done. I guess time will heal my worries. I just still wonder if I need to be tested out to 6 mos to be 100% sure. That is probably the one lingering problem I have right now...and I need to convince myself that it is very unlikely I was exposed to anything during my allergy test.
To Nonbeliever- I think testing neg out to 11 mos is more conclusive than anything else you have in your life right now. Your body isn't all of a sudden going to produce antibodies past 6 mos...you'd be the first ever. I hope you can get life back to normal too.
To Nonbeliever- I think testing neg out to 11 mos is more conclusive than anything else you have in your life right now. Your body isn't all of a sudden going to produce antibodies past 6 mos...you'd be the first ever. I hope you can get life back to normal too.
Our study has limitations. Eligible participants were only those whose HIV diagnosis occurred within the previous 12 months. The period during which the STARHS can detect recent infection is limited to a maximum of 200 days, thereby providing a narrow window during which recent infection can be defined. The Vironostika HIV-1 enzyme immunoassay test for detecting recent infection performs differently on non-B subtypes than on B subtypes.[13] In an analysis of the first 645 specimens in this study, however, only 1.6% were non-B subtypes.[14] Thus, we believe that the STARHS results in this study are unlikely to have been affected by differences in subtype. Because participants were recruited in a nonrandom fashion from clinics selected for their capacity to identify and recruit untreated HIV-infected patients whose HIV diagnosis was recent, selection bias may limit our ability to generalize the risk of new infections. Nevertheless, the sample was large and geographically and demographically diverse. In addition, the sampling method made it difficult to determine whether the factors associated with recent infection reflect a true risk for new infections or testing and care-seeking behavior. Thus, it is important to interpret the findings from this study in conjunction with results from other studies.
Our finding of recent infections in 20% of persons whose HIV diagnosis occurred within the past 12 months indicates that relatively few people receive their HIV diagnosis shortly after acquiring infection. Studies have demonstrated that persons who become aware of their HIV infection reduce risk behavior, and thus HIV transmission.[15,16] This highlights the need to expand HIV testing so that diagnoses of infected persons can be made early. Newer testing strategies, such as rapid tests, making HIV testing a routine part of medical care,[17] and RNA testing to detect acute HIV infection[18,19] may possibly be effective in this effort. Application of the STARHS to a larger population of persons with a new diagnosis of HIV infection is one method of identifying those populations in which HIV diagnoses are occurring late so that diagnostic and prevention efforts can be appropriately directed. Several laboratory methods to detect early HIV infection before and after seroconversion are available or under development and should allow for continued measurement of HIV incidence and characterization of persons with recent HIV infection.[20]
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Our finding of recent infections in 20% of persons whose HIV diagnosis occurred within the past 12 months indicates that relatively few people receive their HIV diagnosis shortly after acquiring infection. Studies have demonstrated that persons who become aware of their HIV infection reduce risk behavior, and thus HIV transmission.[15,16] This highlights the need to expand HIV testing so that diagnoses of infected persons can be made early. Newer testing strategies, such as rapid tests, making HIV testing a routine part of medical care,[17] and RNA testing to detect acute HIV infection[18,19] may possibly be effective in this effort. Application of the STARHS to a larger population of persons with a new diagnosis of HIV infection is one method of identifying those populations in which HIV diagnoses are occurring late so that diagnostic and prevention efforts can be appropriately directed. Several laboratory methods to detect early HIV infection before and after seroconversion are available or under development and should allow for continued measurement of HIV incidence and characterization of persons with recent HIV infection.[20]
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