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Lifespan and Resistance.
Nov 27, 2003

I have a 3 part question. Let me start of by Sayin I tested positive about a year ago. I found out because my lover turned up positive at the time I took an HIV test and west negative but had a Viral Load of 750. We both decided to go onto meds early. At the time I started taking meds my Antibody test was now indetermenant and a VL of 7000 I achived viral suppression within 18 days or so. My current CD4 count is between 1000 - 1200 and 40 or better based on roughly 6 months of tests. My question is this I am contantly hearing about expected normal lifespans but yet hear information on HIV new about people indicating a 10 year expectency provided Meds were taken before a CD4 count of 300 and Then the most recent one indicating a 90 survival rate of 5 years for those taking meds immediately. See link

http://story.news.yahoo.com/news?tmpl=story&cid=571&ncid=571&e=14&u=/nm/20031106/hl_nm/aids_therapy_dc_1

With this much news for an against long term survival I am not sure where or whom to believe.

Secondly, Its been widely argued allthough a person is below 50 copies IE undetectable, That their is still replication being achieved most likely in hidden or CSF / Brain compartments and that over time those copies will be enough to break through even the strongest of Meds and theirfore produce resistance even in someone that is 95-100 compliant with meds What is your take on that.

Thirdly, I am the type of person that has to be in ultimate control. And find myself reading countles articles and developing some of my own hypothesis. One of which is that Within 6 months of meds I found a doctor that would administer OKt3 which obviosly activated T- Cells since I could not get out of bed for 4 days all I had to eat and drink was my Meds and a few crackers In addition I have been taking Hydrea in an attempt to push the CD4 counts down and then get several types of vacaines most recently yellow fever and Encephalitis Typhoid. This is in an attempt to force naive CD4 cells and cells that are dormat to activate. Not necessairly as a cure but to force what ever I can out to create a Cyrtonic state and die in hopes of getting that much more HIV latent cells. The question I have is this the idea was to try and remove all the latent cells I possibly can. Then fo off meds for just enough time to get a VL of 1000 or Better and then back on, And repeat the steps a couple of time 1. To create more brodaly neturalizing CD8 cells, 2 to Create more CD4 Cells that are more keen at uncovering and destroying HIV. This is kinda like a self vacine which I belive scientist believed occured over time with the Chimp since the Chimp allthough can get SIV their body simply has managed to live harmonously with it and find that a Chimp will live out their normal life span with SIV.

Also What is your take on the Small Pox Vaccine. Being believed to mutate the CCR5 receptor cell making it impossible to nearly implossible for HIV to doc and release its genetic material into a healthy host CD4 Cell?

Thanks

Response from Dr. Pierone

Hi, wow, where to begin?

We have a number of cohorts (large groups of patients) that have been followed since the advent of HAART and the study that you reference is from the ATHENA cohort in the Netherlands. This cohort did not take medications immediately as is suggested in the article, but rather started meds at an average CD4 count of 220. People stop meds for many reasons, but high on the list are mediation-related toxicity and development of viral resistance. Not surprisingly, at this CD4 count, those that took medications continuously did better than those that did not.

In a general sense though, it is not possible to look at 4 or 5 years worth of experience with first generation HAART and pretend to make accurate predictions about ultimate survival. The average 39 year old has an estimated actuarial survival of about 44 years. The average 39 year old newly HIV-infected person has an estimated survival that will likely be less than 44 years. But how much less, no one knows.

The worst case scenario for average survival would be 10 years based on natural history estimates of untreated HIV infection. This assumes that HIV medications don't work (or work a little, but toxicity cancels out the benefit). This would be a minority view, but there are some extremely pessimistic folks around (how do they even summon the will to get out of bed in the morning?).

The best case scenario is that the average survival for an HIV infected person would be 43.9 years, just shy of expected for HIV negative. One would have to subtract a little for to account for the risk of dying in a car accident on the way to the clinic. This assumes that all persons have access to HIV medications, the meds are 100% effective in controlling virus with no toxicity, and all persons demonstrate perfect adherence.

The truth to long term survival is somewhere in the middle - or perhaps not. If intrepid researchers develop the anti-aging wonder drug 20 years from now, then all bets are off and our un-infected 39 year old get another bonus 20 years of life. Maybe our HIV-infected 39 year old gets another 20 years too. My point is that we really don't have a clue as to what is going to come along decades into the future, only that it is going to be better than we have now.

My personal view (optimist that I am) is that HIV-infected persons that have access to treatment, and life skills necessary to adhere to treatment, will have near-normal longevity.

The data on development of viral resistance in people with undetectable viral load is mixed. A few studies have shown some viral evolution, others have not. We now have a few studies going out to 5 years of follow up and very few people develop late resistance suggesting that it's not a significant issue. (I know, I know - we could see resistance develop at year 20)

Your unorthodox approach to treatment is interesting, but highly experimental. The one thing you apparently haven't tried yet is having your body cryogenically frozen at -380 Celsius now and thawed out in 2081 when treatment will undoubtedly be more advanced. Let us know how that goes.



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