Q: I a seaman by profession. Just 5 months back, I was tested HIV positive. I did the ELISA tests in my hometown & repeated that along with the western blot test in Mumbai. All came positive. Anyway, the confusion is as follows: 1) The 1st test was done 5 months back. Also did the CD4/CD8 counts, came 473 & 1215 respectively. Was then advised by my doc not to start with ARV therapy. 2) Again last month, I did the tests again. I got the CD4/CD8 count as 231/1115. I also did the viral load test at the same time, which however showed that the virus was less than the detectable limit. ARV therapy started after I got this CD4 count result. 3) My doctor then asked me to repeat the CD4 count as he was advised by mumbai doctors that the CD4 and viral load results don't tally of the above. So we did it again in another laboratory. This time the CD4 count came 661. Western blot also came + (only HIV 1). Whats going on? Can we trust all the labs? I had started taking the ARV therapy (EFFAVIR & DUOVIR of Cipla pharma) when I got the second result of CD4 last month). But had to stop it within 5 days as had side effects of nausea,loss of sleep, depression. Also, since CD4 count showed 661, doctor advised to stop the therapy. The only symptom I have at present is penile warts which came 5 months back. Then when I started the ARV therapy last month, they vanished within 15 days. Now, that I have stopped the therapy, they have come back again. My wife had done the HIV tests (only ELISA) twice. Once in may and now last month. Both luckily came negative. The main question which I need to ask you: Can we have kids with being HIV positive???? I have heard about artificial insemination? Is it possible with HIV positive patients?

A:There is no doubt that you are HIV positive and it appears that your wife is HIV negative. Are you using protection for sex with your wife? If the two of you want to have a baby you should be aware of the consequences. As you will have unprotected sex, there is a chance that your wife will get infected with HIV. The usual HIV test does not become positive for several weeks, upto 3 months, after infection. To get an earlier diagnosis you may have to depend on a PCR test. Without treatment the child born to a HIV infected women has a one in three chance of being infected. However with proper treatment this chance of infection can be very much reduced. The drugs should be taken as advised by the treating doctor. A careful delivery by caesarian section also reduces the chance of infection. The baby must not be breastfed if you can afford artificial feeds. Please keep in mind that you and your wife have to consider the possibility that she may get infected in the process of trying to conceive. You also asked about artificial insemination. If your semen is used, the chance of infection exists. Of course if semen from another donor is used there is no chance of infection. You have to discuss this issue with your wife. I have read of artificial insemination with washed spermatozoa to reduce the risk of infection. This possibility may be discussed by both of you with a specialist in artificial insemination. As regards your test results. Generally we do not advise starting ARV until the CD4 count gets below 200 or if other specific indications are present. I can not comment on the viral load / CD4 discrepancy and you may ask your treating physician for comments. After ARV however you can expect the CD4 count to increase and the viral load to fall. That is not an indication for stopping treatment as the purpose of taking ARV is to improve the immune function and to reduce the viral load.