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May 17, 2001

Since you seem to be the nicest one on the group, and the only one answering questions, I will direct my question to you. Please keep up the good work.

I started HAART a few months after I was exposed to the HIV virus. My initial HIV test was inconclusive, but my viral load was not. I had come to see my doctor about flu like symptoms I was experiencing. She concluded that I had been infected several weeks earlier.

When I start HAART my viral load almost immediately became undetectable <25, and my tcells count soared. The NIH asked me to be in a possible Structured Interruption Treatment study. I declined because they wanted two study groups. One was a STI control group and the other was a continuous treatment group. I declined their offer because I had no control over which group I would be selected.

After a year on HAART I decided to stop my treatment for about a month to see what would happen with my doctor's consent. Much to my surprise my tcell number increased by 200 and my tcell ratio jumped, and my numbers were considered in the normal range before this happened. I stopped my meds again in March and have had incredible success. My tcells count is 800, ratio is 37, and my viral load is undetectable.

My success seems t be consistent with others who have started HAART during the acute phase of infection. In your opinion, what do you think is going on here? I'm reluctant to use the word "cure", but this seems to good to be true. What do you think is going on with my immune system, and can I expect to be able to control this virus for lifelong?

Response from Dr. Young

Thank you for your kind comments and question.

You're right in that your virologic and immunologic responses to HAART during acute infection are excellent. Several research groups, namely Walker's in Boston and Fauci's at the NIH have seen remarkably low viral loads in patients who had treatment of HIV during initial seroconversion. For these few patients, there appears to be preservation of the immune response to HIV (in contrast to patients started on treatment once the infection is established) and lower than expected viral loads (if treatment is discontinued). At the very least, one could expect that these low viral loads should translate into very slow (or no) disease progression; hence these patients and you could expect to be classified as long-term non-progressors.

As to how long this effect might last, it is not very clear from the prospective studies, however, in the few long-term non-progressors that I have been taking care of (and from other practitioner's experience), it would seem that you should do very well for a very long time, even without HAART treatment.

thanks again and good luck, BY



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