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Inmune reconstitution syndrome
Feb 19, 2007

Dear Dr. I had 2 cd4 cells, now after 6 months of antiretroviral therapy my cd4 count is 52 and my viral load is 2000. Iam just getting better of a very bad month in the hospital i got what doctors called "INMUNE RECONSTITUTION SYNDROME" My doctor says iam better know and that i will get better. I would like to know your opinion on this cause i was so bad that i almost died i was with anemia fevers and i needed 15 blood transfutions. In your proffessional opinion do you think that if i take my medication faithfuly and i take good care of my alimentation and stuff i will be able to live a "NORMAL" life? Do you think is possible for me to live like many other hiv possitive people for 15 years or more praying always for the cure to appear? Please tell how long do you think i can live. Thank you very much for the help you give. By the way i live in Bolivia, and thanks to god i can afort the medication.

Response from Dr. Sherer

Yes, even people with HIV with very advanced disease and very low CD4 cell counts when they start ART can have a remarkable recovery and lead a normal life.

You have had the difficult condition known as 'Immune Reconstitution Syndrome', in which the road to recovery is suddenly interrupted by a new and often severe syndrome in which the immune response to an opportunistic infection is stronger - due to the good response to ART - and so you, the patient, suffers a new clinical illness.

The good news is that your doctors recognized and diagnosed the IRS. It can often be complex to manage, because a patient may already be on the appropriate ART and appropriate treatment for their opportunistic infection(s), and simply need temporary therapy to dampen the inflammatory immune response with corticosteroids and/or non-steroidal antiinflammatory agents.

So, in spite of the very difficult course that you have had, there are good reasons to be hopeful. The hardest part of ART everywhere, and particularly in more resource poor settings, is the first six months of ART.

So stay completely adherent to the medications, keep all of your doctor appointments, and keep your hopes up. And, of course, talk to your doctor about your concern and these comments.

Assessing first therapy options vs. side effects
Resistance, falling blood counts, and current options

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