Good to know. Then this may represent a case of what is called a post treatment controller.
In any case, I would personally restart a suppressive ARV regimen. We wouldn't want him to have viral rebound and not know it, and then put his sexual partner or partners at risk for transmission.
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Adam Zweig
AIDS Healthcare Foundation
San Diego CA
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Original Message:
Sent: 08-07-2023 15:54
From: Hermeyone Bell
Subject: HIV-1 DNA Not Detected
Thank you so much Drs. Hardy and Zweig. I have repeated the antibody test. His initial test was not a fourth generation and initial HIV RNA was 4400 copies. I am going to monitor him closely. Thanks again.hb
Sent from Hermeyone's iPhone
Original Message:
Sent: 8/7/2023 3:20:00 PM
From: Adam Zweig
Subject: RE: HIV-1 DNA Not Detected
Hermeyone,
Yeah. I agree. A + HIV DNA test would help you. But if it is negative, that really doesn't help, because the latent viral population may be small.
Could you find the 2017 records to confirm that that the HIV antibody test and confirmatory test, as well as the HIV RNA were positive? Also, could you recheck a fourth gen HIV test and confirmatory antibodies? If +, these would help you establish the presence of infection. If negative, though, the possibility of a prior false + test, or consideration of possible seroreversion would have to be made. Not easy sometime!
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Adam Zweig
AIDS Healthcare Foundation
San Diego CA
Original Message:
Sent: 08-06-2023 17:39
From: W. David Hardy
Subject: HIV-1 DNA Not Detected
Dear Hermoyone,
If your patient's VL is and has been undetectable, the amount of HIV DNA (latent reservoir) is ~ 1 CD4+ cell/ million cells.
So, detection of integrated HIV DNA often requires at least ~100+ mls of whole blood.
David
-- W. David Hardy, MD
Scientific and Medical Consultant
Attending Physician, LA County-USC Rand Schrader (HIV) Clinic
Adjunct Clinical Professor
Keck School of Medicine of USC
wdavidhardymd@gmail.com310-709-3505 (Mobile)
Original Message:
Sent: 8/6/2023 1:20:00 PM
From: Hermeyone Bell
Subject: HIV-1 DNA Not Detected
Greetings-
I have a patient who has been living with HIV since 2/2017. Treatment was started day of diagnosis. He had a change of ARV regimen due to adverse effects in 4/2021. He had an interruption in therapy due to insurance changes. Prior to restarting ARVs, HIV RNA was still not detected. This made me curious about his initial HIV test. I recently obtained HIV-1 DNA, Qual, PCR and the result was Not Detected. Is he not living with HIV? Was the initial HIV test result a false positive? Thanks in advance.hb
-- Hermeyone Bell, APRN, BC, AAHIVS
Nurse Practitioner
Bell Primary Care, LLC
P:404-337-7486
F: 352-329-4338