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Rapid Progression and
Feb 18, 1998

I've been holding off on writing because eventually all my questions get answered, but your recent response about "setpoints" and early treatment confused me. I'm one of those unfortunate people who got hit very hard right at first. I was negative Jan. 97, but got very sick April 97. Elisa in my doctors office was negative, but 3 days later I was in the hospital with extreme fatigue, fever, and what my doctor called "the biggest ulcer I've ever seen" in my esophagus. A few days later my ElISA became weakly positive, and on that day I had full blown AIDS, with CD4 of 158.

One week later my CD4 was up to 350 and my viral load was found to be 285,000. I started AZT+3TC three days after leaving the hospital, and had to resume work as a long haul trucker the next day. I would have preferred a longer convalescence! But about the setpoints, my doctor only said we wouldn't be able to tell what improvement in viral load was due to the meds, since I was so newly sick, that my body would eliminate a lot of it. One month later my V/L was down to 3,000. I started Viracept in August, and as of Nov. 1, I am undetectable (<40), CD4 back down to 254, but percentage up to 29%. I am tolerating the meds perfectly, and never miss a dose.

My question is, am I at risk for rapid progression because of how sick I got, and if so, has starting the meds so quick "leveled the playing field"? Am I also at risk for rapid treatment failure? My doctor is already talking about what we can try next, which makes me mad, since I am doing fine now. Also, how common is it for people to get full blown AIDS during the acute retroviral syndrome period?

Thanks for this great forum, and keeping your sense of humor while doing it.

Response from Dr. Gallant

You asked if you were at risk for rapid progression. I don't want to alarm you, but that's already happened. You started out with a very low CD4 count after recovering from the acute retroviral syndrome. Most people would have taken many years to get to that point.

That doesn't mean, however, that you are at risk for continued rapid progression. Now that you are on effective therapy and have an undetectable viral load, you shouldn't progress at all. Your CD4 count may not rise very far, but as long as your viral load is this low, you'll be quite stable.

The four month (?) delay between starting AZT/3TC and starting Viracept is a little concerning, but since your viral load is JG


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