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Early Treatment & HIV Specific Immunity Study
Dec 12, 2000

Dr. Cohen, Regarding the theory on early treatment, it certainly makes sense to me. I'm an optimist. (I read your synopsis of the presentation made last Dec. in Boston.) Having said that... is there any indication yet on whether an HIV specific immunity can be created when treatment is started several months (say.. 3 1/2 months) after infection? Is it possible that the acute infection phase would last for up to six months? I'm fishing for hope here should HIV specific immunity be proven, as I started treatment 3 1/2 months after infection. Facts: four tests during a 12 week period following infection indicated the respective results: VL levels of 54K, 60K, 42.5K and 47.5K; CD4's trended from 570 to 417 to 298 to 306; and CD4% trended 42%, 32%, 26% and 28%. BTW, my healthy baseline for CD4's when HIV-neg. is approx. 700 (680-720). After 4 weeks of Sustiva/d4T/3TC, VL is a mere 81, CD4's are 432 and CD4% is 39%. Any indication I may have fallen into the window for creating HIV specific immunity at which these new studies for early treatment are aimed? Any other thoughts on my case in terms of this particular study?

Thank you for your dedication and hard work!!!

Response from Dr. Cohen

Yes it is possible that a few months after infection the cells required to create HIV specific immunity might still be there. It is not clear how long these cells last - and clearly is variable. In fact, there are some for whom they never are lost - those are the long term slow/non progressors. So if they are on one end of the bell curve, then likely others will have variable amounts of time these cells are there. And as mentioned, there is active research now into defining who still has these cells, to what extent they are there, and how to increase them if they are there in low numbers; there is also research into how we might recreate them if lost. (You don't mention how you know it is about 3-4 weeks after infection - and to clarify for others - the key issue is time since initial exposure/infection, not time since first testing positive. People can first test positive years after infection occurred...)

There is nothing about your response to meds that can help clarify whether these cells are there or not however - in that your viral load drop was the expected approximate 2 log drop on this triple combo in the first month (in your case even more than 2 logs drop in a month). From the T4 count boost, your immune system is able to reverse the damage done, however brief that damage was going on. But these improvements can happen to those who start treatment a few months as well as a few years after infection. So we can't tell from this...

In the next years, researchers will likely develop tests that will allow us to see these cells if they are there, and inform your decision making about how to approach treatments over time. For now it sounds like you are doing well, and should continue to do great. Just remember to take them each day...

Hope that helps.

CC

Cal Cohen, M.D., M.S.



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