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HIV+ to AIDS and back to HIV+??
Jun 9, 2007

Dear Dr.

I have been positive more than 20 years. There have been ups and downs throughout those years, the downs being mostly in the latter half. I was officially diagnosed with "AIDS" about 8 years ago when I had wasting (50 pounds loss in 2 weeks) and my CD4 went to 19. There were other factors as well but not life-threatening opportunistic infections. (Thrush, shingles and serious HIV med reactions)

My question is, once I have been diagnosed with "AIDS" is that forever or do I revert back and forth from AIDS to HIV+ depending on my clinical presentation and/or my CD4 count or will I always have "AIDS"? This question has mostly to do with my disability status which I still feel I am, due to a lot of HIV related stuff just not life-threatening.

Thanks for your help.

Response from Dr. Daar

I personally do not like to spend a lot of time focusing on the diagnosis of "AIDS." I find it much for useful to consider how a given patient is doing at the present time. Everyone with HIV is "HIV+" so this is a non issue; the question is whether the patient is suffering the consequences of HIV infection, the more extreme cases meeting the arbitrary definition of "AIDS" set out by the Centers for Disease Control (CDC).

It sounds like you previously met CDC definition of AIDS by having wasting and a CD4 cell count of less than 200 cells/uL. I don't know exactly where you are now, but often someone like you starts effective therapy, gains back all of their weight, has normal CD4 cells and in my belief will likely live a long, healthy and productive life. In the hypothetical scenario I describe the patient may have had AIDS, but it that is in the past and not terribly relevant now or for the future.

The issues surrounding disability are more complex and must be individualized based upon discussion with your provider. In my view this should not be based upon whether someone met the definition for AIDS in the past, but rather how they are doing now.

Best, Eric


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