Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. Hence the body continues to fight against the alien intrusion and produces antibodies which can be only detected by an antibody test. How does the pharmaceutical industry differ from other industries? HIV may be considered as a differential diagnosis for patients who present with prolonged fever and respiratory symptoms. Can PEP affect the antibody test? We offer this Site AS IS and without any warranties. 3) Anti-HCV (antibody hepatitis C virus). Window periods are likely to be several days longer when testing samples of fingerprick blood or of oral fluid, as will be normal when using rapid, point-of-care tests and self-testing devices. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. 554 Burket's Oral Medicine. However, the key word here is mayas in, although PEP or PrEP may delay the HIV antibody test window, it is not guaranteed to do so. Talk to your doctor or another member of your healthcare team for advice tailored to your situation. London SE1 3LJ.Tel + 44 (0) 208 616 2210. It also can show how your body reacted to COVID-19 vaccines. The best test to know whether or not you were exposed to HIV is the viral load testHIV-1 RNA PCR testwhich can measure particles of HIV within 48 hours of exposure, he tells TheBody. Key enzymes of this pathway are pyruvate:ferredoxin oxidoreductase (PFOR) and 2-oxoglutarate:ferredoxin oxidoreductase (OGOR), which are responsible, respectively, for the reductive carboxylation of acetyl-CoA to pyruvate and of succinyl-CoA to 2 . Our current tests may not be sufficiently sensitive or discriminating to detect HIV infection when the levels of HIV antigens and RNA may be suppressed by PrEP, and the resultant antibody response to them is very weak. http://i-base.info/qa/factsheets/hiv-transmission-and-testing. Can I get HIV from surfaces, like toilet seats? Most are based on second- generation tests, so are likely to have relatively long window periods. There are two types of HIV prevention medications: pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). Should I worry about non-gonococcal urethritis and sexually acquired reactive arthritis? I meant to say, I think the window period extends. baseball font with tail generator. Visit NAMs other websites: clinic.nam.org.uk|infohep.org|prepineurope.org|about-hiv.info|pro-vich.info | hiv-lens.org. Gigi Engle, ACS, is a certified sex educator, sexologist, and author of All The F*cking MIstakes. Clinical Infectious Diseases 64: 53-59, 2017. http://i-base.info/qa/what-are-the-most-asked-questions, http://i-base.info/guides/testing/pep-pepse-and-prep, AFTER MY PEP 28DAY I WAS TESTED NEGATIVE DOES THAT MEAN I AM FREE FROM HIV, No, pls see the FAQ page: All patients need a negative HIV antibody test (4th generation Ag/Ab recommended) prior to initiation of PrEP. Same symptoms doesnt mean you have the same problem. (Some, but not all, infections may be detected at this stage). While on Acyclovir, around three months back, I had a penile lesion but settled within seven days. By using our website, you consent to our use of cookies. PrEP is used by people with high risk to prevent HIV infection. I also took 2 Oraquick tests. Both are available by prescription. PrEP works by blocking the HIV virus from replicating in the body. PrEP is used by people with high risk to prevent HIV infection. Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other abusable medications. Does pep delay antibody production? Registered charity, number: 1011220, Image: ANURAKE SINGTO-ON/Shutterstock.com. antiretrovirals) are designed to address different stages of HIVs life cycle. Our information is intended to support, rather than replace, consultation with a healthcare professional. Immunocompromised patients with COVID-19 may not have detectable levels of antibodies, or have a delayed antibody response. Antigen/antibody combo test: This is a blood test that is sent to a laboratory. Then the very first day started PEP but took 24 days only. The HIV antibody tests gauge the body's immune response to the infection, even if the virus reaches the undetectable levels that doesn't mean that it has been completely eradicated from the body, it's just not present in the blood stream and lies dormant in the body. The window period of rapid, point-of-care tests and self-tests is 90 days. The period between exposure to HIV and seroconversion is variable, but . While results for this assay when testing plasma were broadly similar to those of equivalent laboratory tests, the window period is likely to be several days longer when testing fingerprick blood, as the test is normally used. Home PEP at day 12 is useless, it is only good for the 1st 72 hours if you begin it. Here are the most common reasons for a PEP regimen failure: Here we summarize the testing necessary before starting PEP, post-treatment testing, and testing needed during PEP. Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. A DAT is performed on the blood of a baby to determine if the antibodies have attached to the baby's RBCs.This may occur when an Rh-positive baby is born to an Rh-negative mother. Doctor's Assistant: The Doctor can help. but i took pep, i understand, the windows starts after finishing PEP, am i wrong?, if so, my test were only 3 weeks. The median window period is 18 days (interquartile range 13 to 24 days). Most people are very concerned getting HIV and want frequent HIV testing while theyre on PEP. If the result is negative, get a confirmatory rapid HIV antibody test at three months of last exposure. Company limited by guarantee. (PEP-I1, PEP-I3 and PEP . Thanks. Approved stats until August 2023. Doctor's Assistant: Have you seen a doctor about PEP? The data are based on individuals with HIV-1 subtype B (the form of HIV most commonly found in Western countries) and its possible that tests are less sensitive to other subtypes. There is more on HIV testing here. May 25, 2021. because the windows period for PCR it's just 3 weeks Doctor: Dr. Shah However, others stayed the same. 1) Complete blood count, LFT (liver function test), serum creatinine. Home. The following are considered high risk: If youre not in either of those categories, you can decide whether to be on PEP by looking at your statistical chance of getting HIV (based on the type of sexual activity you had) and your personal wishes. Then again at three months post exposure to be sure. Condoms are the most effective way to prevent HIV and STDs. All tests have a window period, the length of which depends on the marker of infection (HIV RNA, p24 antigen or HIV antibodies) and the specific test used. Plasma is extracted from the sample using centrifugation. Time from HIV infection to earliest detection for 4 FDA-approved point-of-care tests. This is because PEP can delay infection. :(. Another name for antibodies. Commonly used tests of this type include Abbott Architect HIV Ag/Ab, GS Combo Ag/Ab EIA and Siemens Combo HIV Ag-Ab. Company reg no: 3962064. This is because the PEP has been reported as delaying infection if it is not successful at preventing it. why biotech stocks are falling today . We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. jonhny. Can I get HIV from surfaces, like toilet seats? CCP antibodies are produced by the immune system and can mistakenly attack healthy tissues. Now that we have this basic understanding, lets get into the nitty gritty of PEP and PrEP in HIV testing and how it affects the antibody window. Matthew Hodson explains window periods for HIV testing. You have to wait 12/13 weeks from your last dose of PEP to get your reliable test. This page gives information on how soon HIV can be detected by a blood test and when you can be confident in the result. It usually involves taking daily oral medications for four weeks beginning shortly after an exposure happens. Where is your pain mostly, near your anal region or along the urethra? Third-generation laboratory tests are no longer recommended for use. check an HIV 4th gen Ag/Ab test while on week 4 of PEP and prescribe PrEP so the patient can start PrEP the day after PEP is completed. What is the window period for HIV testing? For these, please consult a doctor (virtually or in person). I had a potential exposure on April 10th.next I confirm covid positive on April 24 th .then I did 46 days nd 56 days ofter hiv 4 th generation test.result non- reactive .covid nd post covid status can a increase hiv window period .pls tell me ? Does PEP delay the window period this much? This test looks for the presence of HIV antibodies, or proteins that the body produces when an HIV infection is developing. Email admin@i-base.org.uk In some situations, these figures should be interpreted with caution: British HIV Association, British Association for Sexual Health and HIV and British Infection Association. 169 Tower Bridge Road, If your sympt Read full, Comprehensive Medical Second Opinion.Submit your Case. If I was exposed to HIV and then took PEP, would this affect your confidence in a negative antibody test after six months? Posted on . Is PEP effective after 48 hours? 6 months? 4) VDRL (venereal disease research laboratory test). 21 October 2008. She did frotting against my rectum, I have several fissures that do b After exposure I did a 4 weeks PEP , waited for complete 6 weeks making it 10 weeks post exposure before testing with Alere Determine Hiv 5 weeks ago, I met a girl from another college (23 years old), and decided to have protected sex. Yeah, it's the lack of clear answers and hard data, which makes HIV such a frustrating topic sometimes. Persons being evaluated for PEP because of a sexual encounter should have STI-specific nucleic acid amplification (NAAT testing) for chlamydia and gonorrhea, and a blood test for syphilis Hepatitis B testing, including hepatitis B surface antigen, surface antibody, and core antibody Hepatitis C (HCV) antibody Does PEP or PrEP delay HIV antibody test results? Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. The oldest floret lies in the periphery . Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. Even though I had negative chlamydia and gonorrhea PCR tests. Didn't find the answer you were looking for? . 10 helps us produce news and bulletins on the latest developments in HIV for healthcare staff around the world. Can you get HIV from casual contact, like hugging? PEP is the use of antiretrovirals (ARVs, the same meds precribed to HIV+ patients) to prevent infection following a risky exposure. The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. It's antiretroviral treatment you can take after exposure to HIV in order to prevent infection. There has been no reported case of delayed sero case since 1990. 99% of HIV-infected individuals would be detectable within 57 days of exposure. I think the window period exeends. The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. This camouflage tricks the immune system into leaving it alone. Typically, someone who is taking PrEP medications and not missing doses frequently does not need to also take PEP after a high-risk exposure. By using this Site you agree to the following, By using this Site you agree to the following, The Best IOL for 2022 RXSight Light Adjusted Lens, Will refractive surgery such as LASIK keep me out of glasses all my life. 99% of HIV-infected individuals would be detectable within 44 days of exposure. You need to take them within 72 hours (3 days) after exposure. I took it for two weeks but no improvement. Delaney KP et al. Any donation you make helps us continue our work towards a world where HIV is no longer a threat to health or happiness. Video chat with a U.S. board-certified doctor 24/7 in a minute. All Negative except HSV 1 (It is positive for 15 years). on 4/27 I had vaginal and received oral intercourse with a sex worker and the condom broke for about 3minutes during vaginal.I changed the condom but nonetheless I freaked.so i went to the doctor the very next day.I took pep but only for 2 days because that's all they gave me.I took a pcr test on 6/17.it came back negative and a hiv rapid antibody test 6/28 andit too came back negative.could the pep affected the pcr test and rapid oral test? How accurate are fourth-generation combination tests for HIV diagnosis? Would a 2-1-1 (on demand) PrEP, in which 2 tabs of Truvada before sex exposure and 1 tab for next 2 days after exposure, increase the window period for 4th gen HIV test? (In general, antibody tests that use blood from a vein can detect an HIV infection sooner after exposure than tests done with blood from a finger prick or with an oral swab.). I was really happy with the result and thought that I could move on until I found out that Hepatitis C infection could mean that the 12 week HIV antibody test result would not be accurate due to the Hep C co-infection causing the delay in the body's production of antibodies to HIV. But you have to start PEP within 72 hours, or 3 days, after you were exposed to HIV, or it won't work. Aquifex aeolicus is a microaerophilic hydrogen- and sulfur -oxidizing bacterium that assimilates CO2 via the reverse tricarboxylic acid cycle (rTCA). Your email address will not be published. im panicking, i read that PEP alters antibody production. Why routine multiple HIV tests are unnecessary during PEP. Theroratically it can delay. The PCR test is essentially an HIV viral load test. should not change the window period. They can detect immunoglobulin G (IgG) antibodies and immunoglobulin M (IgM) antibodies, but not p24 viral antigen. So the real question is: If for some reason PEP or PrEP doesnt succeed, will it take longer for an HIV test result to come back positive because HIV medications are already present inside a persons body? NAM is not responsible for the content of external websites. We believe independent, clear and accurate information is vital in the fight against HIV & AIDS. It also depends on the specimen that is being tested: window periods are usually reported based on a sample of blood plasma, but are longer when the specimen tested is fingerprick blood or oral fluid. 99% of HIV-infected individuals would be detectable within 50 days of exposure. Related: All topics, HIV testing, PEP/PEPSE. Getting Tested for HIV, CDC. An antibody is a protein substance produced by the immune system in response to a foreign organism (such as bacteria, virus orparasite). Just a couple quick questions before I transfer you. This chapter provides practical information on HIV post-exposure prophylaxis (PEP) and will help you make a decision about whether PEP is for you. Thank you for taking the time to confirm your preferences. Information on this website is provided by treatment advocates and offered as a guide only. Will post-exposure prophylaxis alter the results of fourth generation HIV test? For most practical purposes, in November of 2017 when I'm writing this, PEP means a 28-day course of Truvada, the only medication approved by the US FDA for use as PEP. After this, it is recommended that they get tested again at three to six months post-exposure to fully confirm that they are HIV negative, according to Chanel Marshall, M.S., an HIV health educator with Inova Health System. Saving Lives, Protecting People, Centers for Disease Control and Prevention, U.S. Department of Health & Human Services. MedHelp is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. Hello doc, after the last dose of PEP when is a 4th generation combo test conclusive? You can upload files and images in the next step. I had intercourse six months ago without a condom (but after six months of intercourse, she checked HIV antigen and antibody, p24 - negative), but she was positive for HSV 2. The test can provide information about how your body reacted to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). PEP is a series of pills you can start taking very soon after you've been exposed to HIV that lowers your chances of getting it. Unfortunately, precise figures for how much longer the window periods are have not yet been published. I do believe symptoms & hiv tests can be delayed due to PEP. Nevertheless, true failures without recognized defects in management have been reported [ 2, 3 ]. MedHelp is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. However clinical experiences suggest towards opposite. Did you have any fever with your symptoms? If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. As far as HIV is concerned, you can consider your test result conclusive if there is no further exposure. This stands true in your case as well, even if you had taken PEP (postexposure prophylaxis). Many rapid, point-of-care tests are described as second generation. Never disregard or delay professional medical advice in person because of anything on HealthTap. Consult a doctor now! Individuals who are taking pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP) may have a delayed antibody response, extending the window period. A CCP antibody test requires a blood sample. Understanding a Positive Result, CDC. Just asking another question since my initial one received no response. Thanks? UK guidelines state that 45 days is the window period for fourth-generation laboratory tests. Read our Editorial Process to know how we create content for health articles and queries. what does the hamburger emoji mean sexually; does pep delay antibody test. Q.10. People who had high-risk contact are encouraged by doctors to initiate PEP. The latest news and research on types of HIV tests, Nonetheless, a study by Dr Kevin Delaney and colleagues calculated window periods for a range of HIV testing assays, third-generation rapid, point-of-care tests, pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP), Time Until Emergence of HIV Test Reactivity Following Infection With HIV-1: Implications for Interpreting Test Results and Retesting After Exposure. I had a potential exposure on April 10th.next I confirm covid positive on April 24 th .then I did 46 days nd 56 days ofter hiv 4 th generation test.result non- reactive .covid nd post covid status can a increase hiv window period .pls tell? The bottom line with both PEP and PrEP is that they are designed to stop HIV from getting inside a persons CD4 cells and beginning to replicate. According to the Centers for Disease Control and Prevention (CDC), there are a few different types of HIV tests: Most rapid HIV tests and at-home HIV self-tests are antibody tests, and they usually require either an oral swab or a finger prick. The best advice we can give is to follow CDC guidelines and speak to your health care provider if you are concerned. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. Time Until Emergence of HIV Test Reactivity Following Infection With HIV-1: Implications for Interpreting Test Results and Retesting After Exposure. PEP can delay the body making antibodies. As the body is beginning to make antibodies to HIV, a person may test "indeterminate" (that is, not clearly positive but not clearly negative, either) on an HIV test. We cant seem to find the page you were looking for. However, the next month second week, I had back pain associate with driving and had moderate pain while driving. Monoclonal antibodies are laboratory-made proteins that bind to the spike protein of SARS-CoV- . Yes The median window period is 26 days (interquartile range 22 to 31 days). Adult HIV Testing Guidelines 2020. "People on PEP or PrEP may have a delayed antibody response, which would extend the window period for an antibody test." However, the key word here is "may"as in, although PEP or PrEP. SARS-CoV-2 is the name of the virus that causes coronavirus disease 2019 (COVID-19). UK guidelines state that 60 days is the window period for third-generation laboratory tests. I had a potential exposure on April 10th .next I confirm covid positive on 24th .then I did 46days nd 56 days ofter HIV 4th generation test . The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Giu 11, 2022 | narcissistic withdrawal. Also, after five and half months, HIV antigen and antibody p24 done two times with two reputed laboratories showed negative. Myles Helfand is the executive editor and general manager of TheBody/TheBodyPro. Antibodies develop within days or weeks of your illness and linger in your system for a few months (we don't know exactly how long yet). By: Admin Posted on August 15, 2022. For potential or actual medical emergencies, immediately call 911 or your local emergency service. Antibody test. The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. In patients with acute HIV symptoms or who report a possible HIV exposure in the . Please keep in mind that PEP treatment should not be delayedthe first dose should be administered as soon as possible. Didn't find the answer you were looking for? Then started skin itching (commonplace is upper back but no visible rash) sometimes had formication. The FDA said on May 19 that antibody tests shouldn't be used to test for. In theory, the test will be as accurate with plasma from a self-collected sample of fingerprick blood as from venous blood, including in relation to acute (recent) infection. During the window period, a person can have a negative result on an HIV test despite having HIV. Some people may test positive earlier using this test, but everyone is unique for how long it takes to produce antibodies. Is HIV PEP (Post-Exposure Prophylaxis) Recommended for Me. We offer this Site AS IS and without any warranties. We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. 15 days post pep. They can detect immunoglobulin G (IgG) antibodies and immunoglobulin M (IgM) antibodies. If so, how it increases the window period? You started PEP at 12 days after the risk? Can you get HIV from casual contact, like hugging? In practice, tests are usually done on fingerprick blood or oral fluid and the window period is likely to be several days longer. 149 Prevalence estimates range from 1% to 3%. The researchers analysis confirms that fourth-generation laboratory tests (which detect both antibodies and p24 antigen) detect HIV infections between one and three weeks earlier than older antibody-only tests. 148 A member of the Flaviviridae family, it is closely related to HCV, and at least ve genotypes have been dis- covered. I then checked HIV (antigen and antibody, ELFA method), HSV 1 and 2, VDRL, TPPA, chlamydia, and gonorrhea PCR. version 12.066-7-prod. Aducanumab was the first therapy to demonstrate that removing beta-amyloid, one of the hallmarks of Alzheimer's disease, from the brain reduces cognitive and functional decline in people living . +91-99-432-70000+1 (844) 432-0202 (Toll free for US & Canada). Do not delay or disregard seeking professional medical advice because of something you have read on this website. if the PEP get rids of the virus then the antibodies are only memory cells that keep showing up on the antibody tests but you don't have the virus like babies. 2022. juillet. Is HIV PEP (Post-Exposure Prophylaxis) Recommended for Me. Didn't find the answer you were looking for? PEP (post-exposure prophylaxis), CDC. February 2022. Experts can't agree on whether to use COVID-19 antibody tests to check whether people need a booster shot. People on PEP or PrEP may have a delayed antibody response, which would extend the window period for an antibody test.. Their window periods are similar to those of the INSTI third generation rapid test (plasma samples), but a little shorter (median 23 days). It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. NISHIr~URA, M.: Delayed fluorescence from bacteriochlorophyl I in Chromatium vinosum chromatophores: characteristics in the presence of o-phenanthrol ine. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Frequency of HIV testing depends on your risk. Condoms are the most effective way to prevent HIV and STDs. I had vaginal intercourse and condom broke. Conference on Retroviruses and Opportunistic Infections, abstract 565, 2018. April 9, 2021. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Can pep suppress to detect HIV after window period (3 months) if pep is started after 2 months of exposure assuming HIV virus transmitted. I am first going to mention the best part of the complete description given by you: 1) Both the partners, with whom you had exposure, were tested HIV (human immunodeficiency virus) negative. May 13, 2021. Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. A fourth-generation laboratory test is recommended in UK and US guidelines. When HIV enters the bloodstream (usually through unprotected intercourse or needle sharing), it latches on to a type of white blood cells called a CD4 cell. Then after four months of exposure (the second girl, because I think the first girl cleared HIV, she did HIV test this month and it is negative), I did HIV antigen and antibody CIMA test and HIV antigen and antibody p24 all negative. There are a few reasons people stop the medication: The most PEP side effects are mild and do not result in discontinuation of the regimen. This ensures anyone who is positive will test positive. PEP is a 28-day, three-drug regimen. HIV i-BASEAbout us - In fact, PEP and PrEP typically do not delay the time period when its optimal to get tested for HIV, Morehead-Gee says. NAM is a charity based in the United Kingdom. In addition, PEP and PrEP wont impair the accuracy of HIV tests themselves. What is the difference between PrEP and PEP? be started as soon as possible after the patient receives a positive COVID-19 test and within 10 days of . Additional cards are available for free for up to five family members. If you have had other exposures in the previous 12 weeks, test again. In our 35th year were asking people to donate 35 thats just 1 for every year weve been providing life-changing information. COVID-19 antibody testing is a blood test. This indicates that half of all infections would be detected between 26 and 37 days after exposure. By using this Site you agree to the following, By using this Site you agree to the following, The Best IOL for 2022 RXSight Light Adjusted Lens, Will refractive surgery such as LASIK keep me out of glasses all my life. Can I Get HIV From Casual Contacts Like Hugging or Touching? Modern tests are accurate and effective. Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. These cookies may also be used for advertising purposes by these third parties. This table shows the most common side effects and the percentage of people who experience them: See a doctor in person See a doctor via telemedicine, 274 Madison Ave, Suite 705New York, 10016, The chance of getting HIV with the kind of sexual encounter you had (youre more likely to get HIV from some sexual activities), The amount of time thats passed post exposure, Treatment should be started within 72 hours of exposure, Ideally, it should be given within the first 24 hours after exposure, Once the decision is made, the first dose should be taken, Unprotected sex with an HIV-positive partner, Its convenientit only has to be taken once a day, Its a better medication for a drug-resistant HIV virus, Not taking the medication as prescribed (missing doses), Delay in starting the medication (ideally it should be initiated within the first 24 hours, but it can be started within 72 hours of exposure), The test usually remains negative because HIV has a window during which infection is not detected, The HIV virus may be falsely suppressed while someone is on medication, People may (unwisely) stop taking the medication because they assume theyre negative after a few negative tests within during the 28 days theyre on PEP, Their partner agrees to be tested and tests negative for HIV, A negative rapid HIV test (fourth-generation antigen/antibody) is usually enough, A negative HIV RNA is necessary if new infection suspected, Their HIV-positive partner has an HIV RNA test showing suppressed virus (undetectable viral load).
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