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Questions beyond virology...
Jul 13, 1998

Hello, my name is Rick. I have been HIV+ since 1987. I have never taken antiviral medications. My CD4 count remains in the 1000 range, my viral load fluctuates between undetectable and 1000 copies, and I have never had OI's or any HIV related symptoms. My question, in a roundabout way, has to do with psychoimmunology.

There doesn't seem to be a lot of "hard" evidence that I know of which demonstrates stress to be a powerful negative influence on HIV progression. But in my experience, some HIV+ people are better at managing stress than others, and those same patients seem to be healthier.

I am not one of those highly resilient people; in fact I tend to become overwhelmed by stress quite easily. To feel less overwhelmed, I use anti-anxiety drugs (benzodiazepines), ideally for short periods, but on occasion I have taken them for too long and have had to go through a painful withdrawal.

I have read about about stress-regulated neurochemicals which adversely affect immune functioning, e.g. the increase in gluticosteroids under stress and their highly catabolic nature in immune function. Most researchers seem to agree on CRF/cortisol as central mediator between stress and immunosuppression.

This leaves me with what may be a controversial question re:

benzodiazepines. From what I understand, a number of fronts are covered by this class of drugs. Among the monoamine neurotransmitters, epinephrine and norepinephrine are reduced by Benzodiazepines. Among the amino acid transmitters, GABA in its inhibitory effects is increased

by Benzodiazepines. Among the neuropeptide transmitters, CRF is reduced by Benzodiazepines.

Could it be that for certain people like myself with "inadequate 'resiliency' " these drugs might be maintaining these neurochemicals at optimal levels, resulting in the reduction of active immunosuppressive agents in

the system and, thus, in an immune stabilizing or strengthening effect?

I'm not suggesting the possibility of a new monotherapy;

I'm just curious about whether or not these drugs I take have some immunological benefit.

As I've talked about this with positive people and the occasional physician, it's been quite striking how

challenging it's become to think beyond the virological aspects of the disease. The virological roads in our minds have been so well travelled that it seems much easier to discuss antiretroviral therapies than the immune system, how it may be regulating itself in certain situations, and how we might help it along.

Response from Dr. Murphy

Dear Rick,

You are reading too much into this. There are a few people, like yourself, who have an immune system that can very effectively keep HIV in check. In your particular case, your cells may be quite resilient to invasion by HIV. Consider yourself lucky. We refer to people like you as "long term non-progressors".

Regarding benzodiazepines and stress reduction, I can't say they have no effect, but on a relative scale, they are insignificant compared to what you have naturally.

Consider yourself very lucky and remember, you are still infectious to others who are likely to not be so lucky, so be careful and responsible.

Good luck.

RM



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