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Treatment
Mar 5, 2000

Dear Dr Cohen

Question :

I am taking Cyclosporin of 350mg per day and I am exposed to the risk of HIV infection ie during the seroconversion stage, my immune system is also heavily suppressed by Cyclosporin. What will be the prognosis and will I develop AIDS much sooner eg within 1 or 2 years after the HIV infection ? What are the treatment options available when I have AIDS and I am a kidney patient too ?

Thank you very much.

Alan

Response from Dr. Cohen

Well... I can't tell from your question if you have HIV infection. Or just worried that it'll happen some day.

But - there is some interest in cyclosporin to actually help minimize the initial damage done to the immune system during initial exposure to HIV itself. While there are few if any real descriptions of what would happen (at least that I have heard about), it might be possible that a medication like cyclosporin - which limits immune activation - could limit some of the initial damage that happens to the immune system when we first do battle with HIV, and be of help in the long run. Here's how.

One of the first things to happen after infection with HIV is that the immune cells get activated to fight this virus. Unfortunately, HIV is also able to target its attack against activated CD4 cells. So the very step our cells use to gear up for the fight puts them even more directly at risk for HIV's attack - a battle the cells usually lose. However - it may be that a medication like cyclosporin - which blunts immune activation - might limit this cellular activation and therefore minimize the number of cells that are lost during this initial infection. If this is what happens - our immune system may actually emerge with more of its cells intact and ready for a longer term defense.

However - this is based on theory. And if you were HIV positive, after this seroconversion process, you would need careful monitoring to see what happens. But with effective antivirals - it is still likely that we can stop the damage done by HIV - and these meds can still work even for those with severe kidney trouble. Some of the doses may need to be changed, but they can still be used. And by stopping HIV's growth, we can limit any further damage to the immune system - even in those on cyclosporin.

Hope that clarifies. CC


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