Viral Blood Levels Don't Indicate Course of HIV Infection

Bill Weintraub

Bill Weintraub

Viral Blood Levels Don't Indicate Course of HIV Infection


Important new research:

Viral Blood Levels Don't Indicate Course of HIV Infection

By Serena Gordon

HealthDay Reporter

Tue Sep 26, 2006

TUESDAY, Sept. 26 (HealthDay News) -- A new study questions one of the basic tenets of HIV management -- that the amount of virus in the blood can accurately predict how quickly someone will progress to full-blown AIDS.

Reporting in the Sept. 27 issue of the Journal of the American Medical Association, researchers explain that HIV levels in the blood aren't a good indicator of how fast important immune system cells called CD4 T-cells will decline. A drop in CD4 cells indicates that HIV is progressing to AIDS. HIV levels have also been used as a major factor in deciding when treatment should begin, and this study suggests that viral load levels shouldn't be used as a deciding factor in initiating treatment.

"The dogma has been that if you know how much virus is in the blood, you can know how quickly CD4 levels will go down. If someone had a high viral load, you would assume that person will progress more rapidly to AIDS," said the study's lead author, Dr. Benigno Rodriguez, an infectious disease specialist at Case Medical Center and an assistant professor of medicine at Case Western Reserve University in Cleveland.

And, he said, in large-scale population studies, that assumption is generally correct. But, Rodriguez said, the researchers wanted to know if the same held true on a patient-by-patient basis.

"When we asked that specific question, based on viral load, how much patient-to-patient variability in progression can we explain? The answer was very little -- 6 percent at most," he said.

To explain how doctors used to think of the interplay between HIV levels and the decline of CD4 T-cells, Dr. W. Keith Henry suggested thinking about a train speeding toward a collapsed bridge. He said the distance to the bridge was the number of CD4 T-cells, and that the speed of the train was the level of HIV in the blood.

"In this analogy, the HIV level is the major factor for cell loss in an individual patient," he explained. But, he said, the results of the new study suggest that the HIV levels only account for about 4 percent to 6 percent of the variability of CD4 cell loss in any individual.

"That means there's a lot more going on than meets the eye," said Henry, who added that these findings should spur new areas of research and may lead to better therapies as well as better diagnostics to help with the decision of when to start antiretroviral therapy.

Henry was one of the authors of an accompanying editorial in the same issue of the journal and director of HIV clinical research at the Hennepin County Medical Center and the University of Minnesota.

For the new study, Rodriguez and his colleagues examined two large groups of people infected with HIV -- about 1,500 people in each group -- over a 20-year period. The study participants had not initiated therapy with antiretroviral medications.

The researchers found that "the viral load for the individual has very little predictive value in terms of how rapidly a person is going to progress to AIDS," said Rodriguez.

In fact, he added, "In our study, we had about 10 percent of patients with low viral loads that had extra rapid disease progression, so people should know that having a low load doesn't mean you're OK."

Both Rodriguez and Henry said the measurement of HIV blood levels is still useful as a tool for mentoring the efficacy of antiretroviral therapy.

Since viral load isn't a good gauge for when to begin treatment, Rodriguez said that anyone with a CD4 cell count below 200 definitely needs to start antiretroviral therapy. And those with a CD4 count above 350 can probably wait to start the therapy, which can have side effects. For those with counts between 200 and 350, Rodriguez said the decision of whether or not to start therapy is less clear. He said an analysis of how the immune system is functioning, perhaps by testing the body's response to a vaccination, can help physicians decide if it's time to start treatment.

"One simple number is not sufficient to tell a person where they are in terms of HIV status," Rodriguez said. "There are so many elements involved in the decision to start therapy, and all of these types of judgment calls cannot be made unless you are under the care of an experienced HIV clinician."

[emphases mine]

Bill Weintraub:

"Having a low load doesn't mean you're OK"

Why does this matter?

Because, as I wrote about in the post titled Blindsided, the HIV / medical establishment has frequently been wrong on crucial issues of danger and infectivity.

For example, we were told for years that one's chance of acquiring HIV in any one sexual encounter with an infected person was very low.

For vaginal sex, as low as 1 in 3000.

And for anal penetration, as low as 1 in 200.

Now, we're being told, per Dr. Myron Cohen's presentation to the President's Advisory Council on HIV / AIDS (PACHA), that the actual efficiency of HIV is:

for vaginal, 1 in 20 to 1 in 30;

for anal, 1 in 8 or 1 in 10.

The real figure for anal, I think, and based on Halperin's work, is even higher: 1 in 3 or 1 in 2.

But no matter how you cut it, the public was very much misled for years about the actual risk.

Now we're being told the same thing about viral load.

As the article explains, it used to be thought that viral load was a predictor of T-cell destruction:

the higher the load, the more destruction.

And the more destruction, the faster the progression to disease -- that is, frank AIDS.

Now we're being told that isn't true.

In fact, [the researcher] added, "In our study, we had about 10 percent of patients with low viral loads that had extra rapid disease progression, so people should know that having a low load doesn't mean you're OK."

"Having a low load doesn't mean you're OK."

Instead, the docs say, look at the T-cell count.

Well, I lived through the era of reliance on T-cell counts, and I can tell you that's not foolproof either.

Oh, you say, but I don't have HIV so none of this matters.

But it does matter.

Because, you see, for years we were also told that having a low viral low, such as guys taking anti-retro-virals (ART) often do, probably meant that the guys weren't infectious.

Maybe they're not.

Would you like to bet your life on it?

If the docs were wrong about low viral load and disease progression, couldn't they and the community be wrong about low viral load and infectivity?

Just as the eminent Dr. Cohen, one of the world's leading infectious disease and HIV experts, was wrong about the efficiency -- the degree of infectivity -- of HIV?

See, one of the reasons there's a big push to get everyone tested is that many people think that if folks get tested, they'll get treated, and if they get treated, they'll be less infectious.

This new study suggests that may not be true.

Which is why experts like Dr. Cohen and Dr. Judson of the PACHA keep insisting "We can't treat our way out of this epidemic."

We need to prevent.

Fact is, a lot of people -- specifically gay men -- have made a lot of decisions based on BAD information.

Such as: it doesn't matter if I don't use a condom this time because my chance of getting infected is only 1 in 200.


Or: he may be poz but if he is chances are he's on antivirals and his viral load is low so he's not infectious.


Then what happens is the guy gets infected and he says -- Boy, was I unlucky.


It's not a matter of luck.

It's what Cohen said:

the efficiency of rectal intercourse changes everything because of the number of dendrite cells, receptors and trauma. So you can never overwhelm, you can't win against anal intercourse.

Anal intercourse is a really bad sexual practice for HIV transmission. It changes the equation.

It's not a matter of luck and it's not a question of odds.

It's a matter of fact: You can't win against anal.

Because when it comes to risk --

It's the anal.

Nothing else matters.

Now, I said there's a lot of BAD information out there.

Here's some GOOD information:

FROT does not transmit HIV.

FROT is incredibly HOT.

Stick with the hottest M2M sex on the planet, stick with SEX the way GOD and Nature intended sex to be, and you don't have to worry about HIV.

Of course you should be Faithful too, you shouldn't be hopping from partner to partner, using your fellow MEN as though they were pieces of meat.

They're not.

You're not.

I'm telling you the truth about Frot, I'm telling you the truth about anal and HIV, and I'm telling you the truth about you.

Listen to me.

Or you can listen to the AIDS establishment.

Which last year was telling you that the efficiency of anal was 1 in 200 and this year is telling you that it's 1 in 8;

and which last year was telling you that having a low viral load means you're OK and this year is telling you that "having a low load doesn't mean you're OK."

It's your choice.

Bill Weintraub

© All material Copyright 2006 by Bill Weintraub. All rights reserved.

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