Dear Dr.: I'm on HAART now for 2 years now, and am doing well, both physically and clinically. Some may call my perception pessimistic; I rather refer to it as realistic. I know that eventually HAART will fail me, and my question to you is, In your practice, what is the AVERAGE time until HAART failure, and do you have any success/fail thoughts to share ? Thanks

In our experiences of just the few years we have even learned how to do this approach called HAART - there are some who are successful for this entire time with no signs of viral rebound. Like more than three years. And we are learning what the key issues are in decreasing the chances for the virus to win this battle... the major issues are to use a combo that drives the viral load to as low as we can - so far we can measure to about 50 copies or so - and to take a combo that you can live with and take each dose each day - since the consistent dosing of a suppressive combo may keep working for years...

And there are at least some studies to show that HIV can be frozen in its tracks when all goes well. And not develop resistance - so far. Will this work for decades? Well, it is difficult to predict the future - we haven't been here before. But there are early signs that suggest room for both cautious optimism, and vigilance since this is far from guaranteed, and there are surprises, and too many examples of disappointment.

You are right to have in mind some plan B - in case this doesn't work forever. Since while there are examples of long term success, there are examples of surprising rebounds when there were all reasonable expectations of continued success and then HIV came back anyway... for many combinations, there are increasing options for plan B. But not always.

So - what is the average time of success? Tough to answer accurately - but I can say this - the longer HIV is suppressed on any combo, the more likely it appears that it can keep working - since viral rebound usually shows up in the first year or so... There is no simple average - there are too many factors that make any numeric answer to that question less than useful for you. But if you got your viral load to below 50 and you can keep taking each dose, then viral rebound is unlikely. Not 100% guaranteed of course. That is why we keep testing - we can't just assume it. Just unlikely.

Hope that helps. CC