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HIV neg aids redux
Aug 19, 1998

Wondering if the small number people who may be classified as hiv neg aids, responded well to treatment. In view of the widely accepted opinion that initiating treatment before or near the time of seroconversion increases the chances of successful results one would expect these people to have responded well since they had not seroconverted. Unless of coarse, favorable effects of treatment during the seroconversion period are because the disease simply hasn't had time to significantly damage the immune system while within the traditional window period of 6 mos. (Hope this question's clear. Re-reading it, I'm not so sure that it is!) In any event, I'd like to, again, commend you on the job you're doing with this site. It's clear that you are a physician in the broadest sense of the word and I wish you well.

Response from Dr. Holodniy

Keep those cards and letters coming! Thanks for the kudos. the number of seronegative HIV infected patients is too small to draw any conclusions about therapy. Several of these cases were found late in disease by other tests (ie viral load, DNA PCR, culture) and it's not clear what therapy was able to provide, at least by what was written in the cases. The issue around therapy in acute infection is somewhat different and not answered yet. Many of the patients identified during acute infection who went on to receive therapy, had already developed positive antibody tests. Thus they had the benefit of antiretroviral treatment and an organized immune response. Their followup has been too short at this point. It is not clear yet what the outcome of patients, who are identified before antibody positivity and treated, will be. That data will come from postexposure prophylaxis studies. Some might argue that you need a full immune response to HIV in order to contain the infection. Thus, giving therapy early might abort a full immune response. Others might say effective therapy very early might abort infection entirely. MH



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