Chapter 77

 As doctor Walter red through the report he  started reading out like he was reading to someone because reading within himself was not giving him the understanding he needed of the case.

This is an official report of the present health status of Mr Andrew Anderson of AA Corporations. Married with a child.

This case report of a HIV diagnosed in late 1999,  displayed stable CD4+ T cell levels and low plasmatic viral load across 12 years of follow-up. In late 2000, the patient started to present an increase in viral load, which is likely to reach a peak of 10,000 copies/ml in early 2001, followed by an oscillation of viremia at moderate levels in the following years. The genetic diversity of env proviral quasispecies from peripheral blood mononuclear cells (PBMCs) will be  studied by single genome amplification (SGA) at six timepoints across 2003-2004 Phylogenetic analyses of env sequences from 2000 and 2001samples showed the presence of a single subtype B variant (called B1). Analyses of sequences from 2011 and after revealed an additional subtype B variant (called B2) and a subsequent dominance shift in the proviral quasispecies frequencies, with the B2 variant becoming the most frequent from 2014 onwards. Latent syphilis related to unprotected sexual intercourse was diagnosed a year before the first detection of B2, evidencing risk behavior and supporting the superinfection hypothesis. Immunologic analyses revealed an increase in CD8+ and CD4+ T cell immune activation following viremia increase and minor T cell subset alterations during follow-up. HIV-specific T cell responses remained low throughout the follow-up period.

Conclusions

Altogether, these results show that loss of viremia control in the HIC was associated with superinfection. These data alert to the negative consequences of reinfection on HIV pathogenesis, even in patients with a long history of viremia control and an absence of disease progression, reinforcing the need for continued use of adequate prevention strategies.

Doctor Walter could see that the report was wrong. No wonder he hadn't mentioned it to him. He was lieingbyk Andrew Anderson.

Now it was all coming together.

Maybe they found out about his lies and they got into a fight or an argument and ended up stabbing him.

Walter went further to read the background of the case report he was holding and couldn't make any sense as to why Joseph would abuse his profession like that.

HIV controllers (HICs) are a rare group of HIV-1-infected individuals able to naturally control viral replication. A fraction of those individuals is also classified as long term nonprogressors (LTNP), as they maintain CD4+ T cell counts > 500 cells/mm3 during more than 10 years of infection without progressing to AIDS in the absence of antiretroviral treatment [1].

Joseph was just looking for things to add to a report that he even added a group of those living with the virus.

How was that Andrew's concern?

An aspect of HIV infection is the possibility of infections by two or more phylogenetically distinct and unrelated variants in a single individual, characterizing a dual infection (DI). More specifically, these DIs are classified as coinfections when all variants are concomitantly acquired in a single transmission event or superinfections (SIs) when the viruses originate from multiple subsequent transmission events [2]. HIV DI has been described in several studies with significant prevalence mainly among key populations [3,4,5,6,7] and is related to a faster progression to AIDS [8,9,10]. DIs were also observed among LTNPs and/or HICs [11,12,13,14,15], with variable consequences on HIV pathogenesis. While some individuals retain spontaneous disease control [11,12,13], others present loss of viremia control and experience disease progression [11, 14, 15].

Joseph was even writing in the future tense. How could he be predicting his patients outcome when the time haven't reached.

It was obvious that Joseph had taken someone else's report and written Andrew's name on it.

The reason behind such an action was still not understood because he seemed to be really close to them.

Doctor Walter went back to check on Joseph but he was still out a d need no disturbance.

He needed to find out more so he made his way to the Anderson mansion.

When Walter got there he saw guards who told him that no one was at home.

He had to go back to the hospital.

He could only wait for Joseph to wake up.

To be questioned.