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and gifts are appreciated!

The study is really good.  I would like for the study to report whatever they find to the doctors of the patients.  I find that dealing with the study so much better then the actual doctor's visit.  They really check and examine you and I have been very well satisfied.  I can't think of anything that could be added to what they already do.  I would like though to know what the study thinks of our medical state.  That would give us more confidence if we were doing well.  What I mean is like when we first start with the study, am I getting better or worse.  I know what my doctor tells me, but it will make it better to hear it from another source.   "

New Viral Load Assays   by Dr. Meg Newman

  new assay is being used to evaluate the viral load (VL) of WIHS study participants.  The older assay could measure levels of HIV in the blood to a level of 1000 copies per/ml of blood.  The new assay can detect even lower levels of virus in the plasma and can detect as little as 50-copy per/ml of blood.

Most women who have had less than 1000 copies per/ml of blood for a year or more than a year are likely to be below 50 copies per/ml of blood on the new assay.  What does it mean if your viral load is now detectable, that is below 50 copies per/ml? 

We had the opportunity to discuss the new assays with two of our local experts, Dr. Jay Levy (a world famous virologist) and Dr. Paul Volberding (the Director of the AIDS Program at San Francisco General Hospital).  We will share their thoughts as well as our own.  The most important thing that everyone agrees on is not to become alarmed if your VL is now detectable between 50-1000 copies per/ml of blood.  Both Dr. Volberding and Dr. Levy agree that every patient needs to be looked at individually and the following questions need to be asked before any consideration of changing therapy occurs.  How is the patient feeling clinically, and what is happening to their CD4

count?  If the patient isn't doing well clinically or the CD4 count is dramatically declining, then a change in therapy should be offered. 

Even if a patient is doing clinically well and she has not yet taken antiretroviral medications, Dr. Volberding would consider intensifying therapy to get the viral load to less than 50-copy per/ml of blood.  He does acknowledge that it is unclear whether being below 50 or between 50-1000 will make a huge difference.  He believes that we need studies to help us answer these questions.  Dr. Volberding stressed how important it is to focus on how the woman feels clinically and to always weigh issues of drug side effects, tolerability, and quality of life when making decisions about adding or changing therapies.

We know from studies looking at how people do with different viral loads that many people feel well and remain healthy if their viral loads stay at less than 10,000 -20,000 copies per/ml.  Dr. Levy feels strongly that many people can do quite well at viral loads up to 20,000-30,000.  Most recently he published a paper in the medical journal Lancet encouraging people not to start antiretroviral treatment until CD4 counts are less than 400 and the viral load is near 30,000.  He stresses that the

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