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Apr 4, 2013

Dear Dr Young

Thanks for your previous answers to my questions about abacavir, miraviroc and CNS penetration. As I said, I have stopped the double dose of abacavir. Since writing, I have also stopped the miraviroc too. I doubt that these changes will make any difference to my HIV. And I decided not to see the neurologist again who put me on these extra drugs. I feel rather liberated from unnecessary drugs and a difficult doctor.

Am going to see another specialist -- in infectious diseases -- to get his view on the way ahead.

I wondered whether you think that the Berlin patient and the two Boston guys whose HIV has perhaps been cured are of significance for the rest of us. The neurologist told me he thought this was important. But it seems to me that unless we are all able to have bone marrow transplants, it isn't. What do you think about the significance of the supposedly cured?

Cheers Simon Australia

Response from Dr. Young

Hi Simon and thanks for posting from Australia. It's good to hear back from you.

There's been much in the news lately of HIV cures- including a lot about functional cures- people with very low or undetectable viral loads after very early initiation of treatment. Then there's the story about the Mississippi child- a case that simultaneously points out the possibilities, but also the deficiencies in our health care system. I previously wrote about these later points in this commentary.

I agree with you that bone marrow transplants are not the way of the future, but taken together, all of these data suggest that we're rounding a corner in the way that the community is thinking about cure. Manipulation and protection of the immune system, whether through very early treatment (like the Mississippi girl) or bone marrow transplantation (with genetically mutant or altered HIV resistance) clearly seems to offer a tenable strategy. What we'll need is a way to accomplish this safely and inexpensively. -or a way to detect people very early after infection so that antiretroviral therapy can be initiated before apparently irreversible infection occurs.

I hope that helps. BY

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