I have been living with HIV since 1982, diagnosed with GRID through an Epidemiology Study. Since then, and to today, I remain antiretroviral-free, with largely stable t-cell counts in the 400-500 range. Over the past year, my viral load has been fluctuating between 20,000 and 180,000. My question is this...why do I continue to develop conditions as esophageal thrush, oral hairy leukoplakia, mulloscum, herpes and neuropathy when my t-cell counts are so high? I've had 2 bouts of community pneumonia over the past 2 years. I'm tired of doctors telling me that my t-cell counts are too high to be getting these persistent symptoms. Why could this be happening? What is the scientific reasoning behind this scenario?

First of all, I would not describe you as a long-term nonprogressor. You do indeed have signs and symptoms related to your HIV disease, and a substantial viral load. Two bouts of pneumonia within a year satisfies one of the case definitions for AIDS, and you almost meet those criteria. And although your T cell counts remain relatively good, they are not normal. It may be that some of your T cells just don't work that well, even though they're still there. We (and others) have documented patients who have had a tremendous T cell and viral load response to therapy, but are still prone to certain infections, and while I think this is a relatively unusual situation, your experience does not sound entirely dissimilar.

Rather than spend any more energy on your false sense of security about your 'nonprogressor' status, if I were you I'd give some hard thought to starting treatment for your HIV. Then you'll have both T cells and a sense of genuine well-being.