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Re: Re: Test Causing Higher VL?
Jul 27, 2003

Dear Dr. Holodniy, Again I thank you for your kind response. You instincts were on the mark given your comment regarding doubt that a viral load assay could cause a higher viral load. And I thank my excellent Physicians Assistant (P.A.) who diligently poured-over the reports from the recent International AIDS Society Conference in Paris to find the report on combination trials of Viread that showed that Viread + Ziagen was a particulary poor combination (the worst of several). My P.A. has advised me to either go back to my AZT + Ziagen combo or switch to another combo with all new drugs.

With regard to your comment about whether you are not a long term survivor/nonprogressor? Id have to say that while Ive obviously survived almost seventeen years with a deadly HIV infection, I am not a long-term non-progressor based on:

* viral loads as high as 14,000 copies/mml eight years ago while on AZT mono-therapy

* CD4+ T cells dipping under 500 cells/mml about two years into the AZT mono-therapy trial (ACTG019)

* I received early treatment that preserved my bodys ability to activate HIV-1-specific nave T cells.

* I and my collective physicians, physicians assistants, nurses and the staff who ran various studies, have all worked very hard to keep my adaptive immune system functional. Throwing away my adaptive immune system to HIV and disregarding the hard work of all those folks would be a crying shame.

* CD4/CD8 T cell ratio only flipping back to normal once, about four years ago when I had the horrible chest muscle inflammation.

* I tested negative for the 32base-pair deletion in my ccr5 co-receptor.

Im disappointed that so many doctors are advocating that their patients not save their adaptive immunity from the destructive power of HIV. I wonder if these same doctors would recommend that their borderline diabetic patients stop exercising, stop watching their diet and stop taking their diabetes pills and "see what happens". Granted a diabetic patient's treatment is nowhere near as toxic as antiretrovirals. And a person with full-blown diabetes could drop into a comma by not taking insulin.

There are zero clinical trials that indicate I could stop my treatment and get better. Several STI trials are now showing the damage that can be done when people stop taking their treatment.

Do you think that AIDS, Inc has given-up (generally speaking) on progressive treatment, only to focus on making more money?

The latest HHS guidelines indicate that nobody should be given mono- therapy or dual-therapy. Yet, there has never been a single trial of recently HIV infected patients that supports that contention. There has been at least one trial that supports the contention that dual nucleoside therapy is a viable alternative for the fairly healthy HIV+ patient:

Dual Nucleoside Regimens in Nonadvanced HIV Infection: Prospective Follow-Up of 130 Patients, Aquitaine Cohort, 1996 to 1998, (2000) JAIDS 23:255-260

I can send you an electronic copy of the above.

American trials in recently infected patients are lagging far behind trials in the rest of the developed world. Trials of Pegylated Interferon-alpha-2a/b have been run for years in hepatitis-B/C patients. Where are the trials of that drug in the recently infected? In 1999 Nesrina Imami, MD et al published the results of a ground breaking trial of IL-2 + GM-CSF + HAART. Seven or eight years after that trial was first started (in Europe) America still hasn't opened a trial that attempts to duplicate its results. It appears that AIDS, Inc is only interested in recently infected patients who are antiretroviral naive, because it is only interested in making more money - not finding better treatments.

An SIV version of DermaVir had incredible results in a small cohort of SIV infected macaque monkeys a few years ago. Yet the FDA has been holding-up an American trial of DermaVir for at least 12 months. This dendritc cell targeted (no dendritic cells are in this vaccine) vaccine is not injected, has no preservatives, and is not contaminated with the artifacts of culture cells from exotic species. During this FDA created delay 14,000 people have died of HIV disease.

Eight years of mono-therapy didnt hurt me because I started treatment early. An additional eight years of dual "nukes" therapy didn't hurt me for the same reason. I preserved my body's ability to both produce naive CD4+ T cells AND to activate them in my lymph nodes. And that is the secret to staying healthy with HIV.

The University of California at San Francisco reported that there was no evidence to support the contention that early treatment might cause people to waste drugs by inducing resistance early in their disease, causing them to run through all their options. I can send you an 8" x 11.5" copy of this poster/abstract. Here is an old link:

http://63.126.3.84/2002/Posters/12670.pdf

Regards,

Tom

Response from Dr. Holodniy

I can't comment on AIDS Inc. or the HIV mafia's agenda about all that you wonderfully reviewed. I am glad to know that you are a wonderfully informed consumer and have great health advocates working along side of you. FYI, there were some interesting and controversial posters presented at the IAS conference last week about giving ritonavir-boosted indinavir as a monotherapy treatment and some interesting retrospective analyses looking at the long term favorable profile of 3TC monotherapy. So, given the expense and toxicity, and the crisis in Africa, some of these monotherapy strategies may become mainstream.



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