Teak and Chris

[needhonesthelp]

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.

[needhonesthelp]

In addition, I would imagine people produce different levels of antibodies to HIV.  Maybe elites and LTNP produce more antibodies and have a strong immune response which contributes to driving a VL down to undetectable levels.  If this was the case, I would think they would have very detectable antibodies early on and certainly by 3 mos.  

Maybe my thought process is off on this which is why I'm asking you.  

[Teak]

Just because one has an undetectable VL does not mean they would have undetectable antibodies to HIV. They would definitely show HIV antibodies on their antibody tests.
It's not that one would have undetectable VL so quickly, it's that they never has a high VL or detectable VL at all. HBV has nothing in common with HIV. One can get acute HBV, get well and due to there antibody production never get HBV again. Then you have ones that have chronic HBV that never really get over it and their signs and symptoms do come back and they are always infectious. You can also get vaccinated for HBV and HAV, to prevent infection but HIV does not have a vaccination. As for a negative antibody test at 3 months or longer means you are indeed HIV negative. As for VL, there are other diseases that can cause a spike in your VL that has nothing to do with HIV. That is another reason VL tests are not recommended do diagnose HIV infection.  

[needhonesthelp]

Thanks Teak...this all makes sense to me.  Again I know this VL test really isn't indicated for diagnostic use.  So what you are saying is someone could have an undetectable viral load early on in the infection and still be positive.  Most likely this is due to them being an "elite" or LTNP.  I guess the only part that gets confusing is if their body controlled the virus to undetectable levels so quickly, does this mean that they would have detectable antibodies to HIV?  Aren't the antibodies the main reason the virus is undetectable?  I'm sure there are some other reasons too, but this is my understanding based on how other viruses funtion.  Take Hep B for example- someone gets infected, develops core antibodies, and if they develop surface antibodies they become immune...their body squashed the virus and they no longer test pos for the antigen.

The main question that lingers for me is simply does a negative VL and negative antibody test give conclusive evidence that someone is not infected.

[Teak]

Yes, it is possible for one to have HIV and a undetectable VL without medication. Those folks are called "elite controllers." There are those that are LTNP that their VL stay very low but are still detectable and their CD4 stays within the normal range. I was a LTNP for 21 years without the need of medication. Then you have those of us that have an undetectable VL due to antiretroviral medications. How is it all known? It's known by continued monitoring testing, that is where your PCR tests come in to play. The majority of us that are HIV positive, have labs taken every three months. Not only for CD4,CD8, and viral load, but also for your CBC's to keep track of your liver enzymes. All antiretrovial medication is toxic to the liver some medication are more toxic to the liver than others. Not only does the medication cause increase of liver enzymes, but has a substantial effect on your cholesterol levels and triglyceride levels. This is why PCR testing is not a good or approved for diagnostic testing in early possibly infected HIV patients. Just because one has no detectable VL does not mean they are not infected with HIV. That is why we have antibody tests, once a test is positive and confirmed for HIV antibodies, there is no doubt that they are indeed infected.