RE: long term progressing to what?

[Guest guest]

At 03:51 PM 12/10/2006, Dean Shaw wrote:

I'm just jumping in on this

e-mail string. I have been POZ for at least 20 years, when tested,

probably 25 really.. I have never been sick relative to my immune

system. My T-cells live around 350, have dipped to 190 once that

was detected. My viral load until recently on a new regimine, never

stayed nondetectable -- around 1,300 2,400 copies; the highest was

in the late 80's when in was 55,000. What category would I fall

into -- long-time nonprogressor or slow preogressor? My cocktail

makes to tired, but other than that I'm very healthy. Any input?

Dean

Slow progressor I'd say since your CD4 count dropped. And also you are on

antivirals, yes?

I think if there are long term " non-progressors " it means

specifically that their CD4 count remains in the normal range for the

duration of their lives. In short, no progression.

I tend to place somewhat more weight on CD4 count than viral load in

general--although, of course, a high viral load will generally correlate

with a persistent decline in CD4 count. So clearly, both numbers are

important.

That is, while overall a low CD4 count is a not great thing, some people

(a minority) seem to have compensatory immune mechanisms that help to

prevent opportunistic infections from developing (e.g., possibly innate

immune responses, natural killer cells, adequate CTL responses?) Others

with higher CD4 counts may develop OIs anyway. But these are the

exceptions and in general, CD4 count or percentage is the critical marker

in terms of remaining healthy.

One of the frustrating things for many is that these tests are largely

unavailable in most developing countries. There are less costly

alternatives for CD4 counting than flow cytometry (which is costly,

requires expensive reagents and special training). Things like Guava

technology, " manual " counts for CD4 and possibly dissociated

p24 antigen for viral load. But these aren't yet widely

instituted.

That's another topic tho....

M.

[Guest guest]

Most insurance companies pay for Interleukin-2 (Proleukin) used by people with HIV. One last hold-out, Anthem (aka Blue Cross of Calif, Empire New York, and Blue Cross in many other states) now pays.

The side-effects of IL-2, when used properly, are barely noticable for most people. If you begin to experience really noticeable side-effects, like fever, you should reduce the dose. Too much is not more effective.Split one 22 mu vial of Proleukin into three doses of roughly 6.3 mu. Inject one dose per day for three days. Do this every other month. If you experience more than very mild effects, cut the size of the second and third doses in half - or even skip them if neccessary.

If you experience an elevated temperature you can use Indocin-SR capsules, one every 12 hours. Don't bother trying other anti-inflammatories, they don't work.Interleukin-2 will not suddenly restore your immune system. The progress will occur slowly and steadily over time. I have used Interleukin-2 since 1994, and since that time I have not experienced any antiviral failures due to viral resistance, although I failed a number of antivirals before using Interleukin-2.

I believe the immune system is an important, and overlooked, component in controlling HIV.

I do not think the strategy of relying exclusively on ever more antivirals, boosted to ever higher doses, will provide long-term success. I think that should be obvious after all these years. They say doing the same thing again and again, expecting different results, is the definition of insanity.

I'm very happy to be healthy after 18 years of HIV and intend to stay that way. I certainly wasn't very healthy 12 years ago, after six years of HIV and several bouts of pneumonia, just prior to using Interleukin-2.

> > > > "It's ghastly, as I said is that so VERY few - 0.5%? 5? Even if it were as high as 10% which I grant you is probably high, it's a tiny fraction. More in line with infections like syphilis." I'm totally missing something here. What in the world does the disease progression rate of syphilis have do to with HIV?Oh, well, it's an issue that denialists have raised, claiming that some people NEVER need ARV because they don't progress. Well, that's a stupid argument as MANY diseases (most?) have a significant number of people in the population who may be exposed and remain uninfected or who become productively infected but do not develop clinical sequelae of the disease (i.e., non-progression).I'd asked what diseases didn't have that kind of a profile. Syphilis infection may be one that, like HIV, the majority of infected individuals go on to develop disease. And syphilis, like HIV, can have periods of clinical latency where things appear to be hunky dory but are not.Other> infections, like herpes simplex, malaria, are relapsing and remitting. TB can be latent and never reactivate in many infected individuals. Infections like Ebola and other hemorrhagic viruses do kill an inordinate number of exposed/infected individuals--but "only" around 40%. Some 60% can survive. Dengue seems to kill young girls, leaving boys to survive.So it was looking at comparing and contrasting of various infections, HIV is pretty horrible as so FEW people are either long-term SLOW progressors--and Iit would seem that a certain percentage may never progress. "Never" of course is a misnomer as we all die of something eventually.Persistently exposed but uninfected individuals have been studied in various cohorts, including gay men in SF, people with hemophilia in Scotland and female sex workers in Kenya. The delta-32 mutation may be an explanation, however only for a small fraction. Other mechanisms of protection have yet to be identified. (Levy's CAF??) It probably> doesn't explain the African prostitutes since this gene deletion is found much more rarely as you go from say Icleand to Africa. Some of the women in the sex worker cohort DID become infected--this appeared to happen, in one study, after a period where they stopped the sex work and then resumed. It may be that the chronic stimulation of immune function somehow was protective but when the triggering stimulus of exposure was ended, the infection could take hold upon later exposure. Suggesting that HIV vaccines may be needed on a frequent basis? M. > > > > > > > > _________________________________________________________________> > Use Messenger to talk to your IM friends, even those on Yahoo!> > http://ideas.live.com/programpage.aspx?versionId=7adb59de-a857-45ba-81cc-685ee3e858fe> >> > > > > > > SEIZE THE DAY! ENJOY TODAY, SMELL THE ROSES AND HUG YOURSELF> > > > ---------------------------------> Access over 1 million songs - Yahoo! Music Unlimited.>

[Guest guest]

"Does most insurances cover this? And, I heard that the side effects were horrible.BUT, if I could get my t cells to 1290, give me those side effects.".IL-2 will boost your T cells.  Despite the impressive individual results reported by someone on this list, of the many, many studies done on IL-2 over the last 15 years, not one has demonstrated any clinical benefit.  I am told that actually proliferative responses needed for CD4 function are simply not seen.There is an on going trial, ESPRIT, looking at this question, but certainly, the benefits have not been so large as to call a halt to the study.IL-2 is not going to be covered by most insurance plans.Let's hope IL-7, which does show enthusiastic proliferative responses, proves safe and effective.  One investigator I know says her main concern at present is that immune response is restored so fast that she's worried about immune reconstitution syndromes.Prolonged, gradual increases in CD4 cells over years are probably a good thing, indicating re-population of lymph nodes by new T cells, rather than movements of existing, partially effective populations.I promised not to raise the issue of IL-2, but when it comes up, I feel obligated to remind people that the medical literature contains little evidence of any clinical benefit from this agent, despite enthusiastic support from some quarters, and almost two decades of looking at it.    Barrowpozbod@...

[Guest guest]

"remember use of P24 antigen testing before PCR viral load testswere available. It was a short duration, but an improvement onT-Cells only. I don't recall if they were unusual or expensive,or "dissociated" P24 antigen."Newer P24 tests are simple, reliable, and used in bulk testing situations, as in blood banks.There is no comparison with the tests of yore and those used now. Barrowpozbod@...