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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.
The odd part about this is if they never had a VL to begin with, how does the body produce antibodies to a virus that exists with such low undetectable levels? It seems like either they produce a lot of antibodies quickly and the VL is never detectable so they have definitely have antibodies or they the VL is so low from the beginning there could be a delayed response in producing antibodies. Maybe it would take longer than 3 mos to produce antibodies if the virus is so darn low and the body doesn't react.
Does the research point to one or the other?
Does the research point to one or the other?
What I actually said is, they either never had a viral load to begin with or never had a very high viral load at all.
I was typing while you responed...my bad. I'm sure it is very complicated. I will take all this info and make what I can with it.
I guess the key takeaway is the elite and LTNP are rare. They may not have detectable VL early in acute HIV or later stages because their immune response was so strong. And they would definitely have detectable antibodies no later than 3 mos. Of course, it almost makes sense that they would have antibodies well before 3 mos if they never had a VL and squashed the levels so quickly since antibodies contribute to control a virus.
Please correct me if any of this sounds incorrect.
I guess the key takeaway is the elite and LTNP are rare. They may not have detectable VL early in acute HIV or later stages because their immune response was so strong. And they would definitely have detectable antibodies no later than 3 mos. Of course, it almost makes sense that they would have antibodies well before 3 mos if they never had a VL and squashed the levels so quickly since antibodies contribute to control a virus.
Please correct me if any of this sounds incorrect.
As I read ur last response again you state that some may never have a VL at all even during the acute phase. Is there research why this may be...does it point to rapid antibody production as the reason. I just figure any other reason for squashing the virus before it takes off...could this means an antibody test would be pos early on 1-2 mos maybe...assuming the VL at this time was neg
Yes they do have antibodies that are detectable at 3 months like most others. As with all folks that test most will have a detectable antibody test at 6 weeks. Don't let the viral load levels and antibody levels confuse you. They are two totally different things. I'm not going to get into the reasons some people are "elite controlers" or "LTNP" it's just to in depth and studies are on going for the reasons.
I hope I read your reply correctly. You saying that if someone has an undetectable VL, they should definitely have HIV antibodies if they are indeed infected. If both are neg then clearly they don't have HIV...
Also, I know HIV is very different than anything else including HBV. Maybe that was a bad reference. I'm just trying to make sure I fully understand how a VL test can be undetectable and yet someone can be infected. It sounds like if this was the case, assuming a few weeks or more have passed, the person would definitely have antibodies which is why the VL is so low because the antibodies drive the VL to undet levels, right?
This is my final thought because I know I will exhaust you with more questions. Thanks
Also, I know HIV is very different than anything else including HBV. Maybe that was a bad reference. I'm just trying to make sure I fully understand how a VL test can be undetectable and yet someone can be infected. It sounds like if this was the case, assuming a few weeks or more have passed, the person would definitely have antibodies which is why the VL is so low because the antibodies drive the VL to undet levels, right?
This is my final thought because I know I will exhaust you with more questions. Thanks
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