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Author Topic: HIV-Infected Infant Cured With Early Use of Virus-Blocking Drugs  (Read 31952 times)

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Offline tednlou2

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Re: HIV-Infected Infant Cured With Early Use of Virus-Blocking Drugs
« Reply #50 on: March 07, 2013, 02:25:43 am »
I have always wondered what effect, if any, the Sustiva I was put on had on my virus.  As everyone and their brother knows by now, I was given Sustiva mono-therapy in the hospital.  I had a CD4 of 171.  The short course that was started and stopped did get me UD and a CD4 over 1,000.  I developed resistance to most NNRTI'S with the K103 mutation, or whatever it's called. 

Since that time in 2008, my labs have been high 600's to high 700's, with an average vl of around 15k.  I did ask a HIV doc, whether that mistake at the cost of resistance could have weakened my virus.  I think he said theoretically, but probably not.  The thinking was my CD4 was artificially low due to being so ill, and it just returned to where it was.  And, that's probably the case.  I am not as knowledgable on these things as so many are.  However, it did make me wonder whether I was really at the AIDS level and that's why I got so ill.  I am sure I am wrong.  I mean, I just wonder.  It isn't something I believe to be the truth. 

Offline Souledout

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Re: HIV-Infected Infant Cured With Early Use of Virus-Blocking Drugs
« Reply #51 on: March 07, 2013, 04:47:59 am »
Do you have any pointers to data/studies on this ?

My understand is that elite controllers just control the virus because of genetic makeup, and it does not rise, not after 7 years, or at any point.
So that would be quite different than what you describe.

"A functional cure for a limited period of time" is not a cure, IMO.

Develop characteristics not a changed genetic make up - meaning their ability to control the virus without HAART . If you define functional cure as a lack of viral replication with the absence of anti retroviral drugs, then they are functionally cured BUT for a limited period of time. I didn't say they were cured, or even functionally cured. And even elite controllers sometimes lose their ability to control the virus over time, losing the status when they do.
Infection sometime April-August, no noticable seroconversion symptoms
Not currently on medication
13/09/12 CD4 672 (33%) VL <40 (diagnosis date)
18/09/12 CD4 ?               VL 43
27/09/12 CD4 ?               VL 127
19/11/12 CD4 676 (38%) VL 959
03/03/13 CD4 642 (32%) VL 291
04/07/13 CD4 791 (33%) VL 26,437 (active cold sore, tooth infection)
18/07/13 ------retest------VL 3704
18/11/13 CD4 802 (36%) VL 65

Offline Ann

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Re: HIV-Infected Infant Cured With Early Use of Virus-Blocking Drugs
« Reply #52 on: March 07, 2013, 08:20:34 am »

PEP is a 1-drug regimen.


PEP is NOT a 1-drug regimen. It's a two or more usual, a three drug regimen.

Sometimes people are only give Truvada, which is two drugs.

More usual, people are given Truvada plus Kaletra. I've been seeing people in the Am I forum lately (most of whom do  NOT need PEP in the first place) being put on Atripla, but this is not a standard PEP combo because of the Sustiva side-effects.

Madbrain, I don't know where you ever got the idea that PEP was only one drug. It's never been one drug. Not even PrEP is one drug - it's Truvada which is two. (Truvada is the only combo approved for PrEP.)

The only PEP-like monotherapy that I know of is when they give babies liquid AZT for the first six weeks of life - and that's usually when the mother has been on meds during the pregnancy and has a controlled viral load.

THIS particular baby was given a three-med combo, probably because her mother hadn't been on meds during pregnancy.
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Offline scottieman

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Re: HIV-Infected Infant Cured With Early Use of Virus-Blocking Drugs
« Reply #53 on: March 07, 2013, 03:48:40 pm »
Thanks for all of the helpful information.  I sero-converted and went on meds at about the 6 week mark, my VL was at less thank 20K copies, and I went to UD almost immediately.  Over the course of the next year, I had a couple months where my VL rose to numbers still under 100 but detectable by today's standards.  I've been on ARV's now since November of 2011, and will continue to take, but hold out some "hope" now that maybe my choice to start meds immediately to preserve my immune system and stop any latent reservoirs was the right choice.  Maybe someday I can safely stop talking medication!  Until then, I am grateful for the medication I can get, and how well it works.
August 19, 2011 Negative Oral Swap
August 30-September 4, 2011 (Thought Strep throat really sero-conversion)
October 5th, HIV Diagnosis
October 22 labs, CD4 619, VL 21,000 21%
November 13th, Started Complera
January 9th, Labs CD4 631, VL-UD 28%
March 28th Labs CD4 610, VL-UD 31%
July 2nd CD4 792, 34% VL-75
August 7th, 2012 CD4 899, 35% VL-97
September 17th, 2012 CD4 989, 33% VL-27
November 8, 2012  CD4 850, VL-UD, 39%
December 6, 2012 CD4 849, VL-UD, 39%
April 2, 2013 CD4 904, VL-UD, 33%
July 17, 2013 CD4 988, VL UD, 38.2%

Offline Matts

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Re: HIV-Infected Infant Cured With Early Use of Virus-Blocking Drugs
« Reply #54 on: March 07, 2013, 03:55:50 pm »
I am not a doctor or scientist, but I think 6 weeks of infection are more than enough to establish a huge reservoir of latent cells. Maybe after immediate treatment (some days) after infection you have a chance to overcome HIV after some months of drug treatment. :(
But You can try interruption, maybe You have a lot of luck. It happened here in Berlin for some patients,  why not for You.
« Last Edit: March 07, 2013, 03:57:53 pm by Matts »
Dovato

Offline anniebc

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Re: HIV-Infected Infant Cured With Early Use of Virus-Blocking Drugs
« Reply #55 on: March 07, 2013, 04:40:19 pm »
I am not a doctor or scientist, but I think 6 weeks of infection are more than enough to establish a huge reservoir of latent cells. Maybe after immediate treatment (some days) after infection you have a chance to overcome HIV after some months of drug treatment. :(
But You can try interruption, maybe You have a lot of luck. It happened here in Berlin for some patients,  why not for You.

Hi Matts

I'm not quite sue if I'm picking you up right, but are you suggesting to Scottieman that he can take a drug holiday?

Jan
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Offline John2038

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Re: HIV-Infected Infant Cured With Early Use of Virus-Blocking Drugs
« Reply #56 on: March 07, 2013, 05:26:35 pm »
FYI

Limiting the size of the reservoir by early treatment (CROI)

Source

..

Patients treated early in acute infection, whether in stages Feibig 1 or 3, showed similar characteristics to 'elite' HIV controllers – a small or undetectable reservoir of HIV DNA, and a bias towards infection of transitional and effector cells rather than central memory cells, concluded Dr Ananworanich. These patients may be ideal candidates for future cure studies which look at the use of therapeutic vaccines in combination with agents that can deplete the HIV reservoir. In due course, treatment interruptions might also be attempted in order to determine whether any of these patients is functionally cured, and if so, what might be the immunologic correlates of a functional cure.

Dr Katherine Luzuriaga also presented data on the characteristics of the HIV reservoir after early treatment, this time in five adolescents with a median age of 16 who had received antiretroviral treatment since soon after birth (median 2 months of age). It was impossible to isolate replication-competent HIV DNA from any of these patients, although proviral DNA was detectable at a low level, and they had no HIV-specific antibody or CD8+ T-cell responses. In comparison, four age-matched young people who had begun HIV treatment in later childhood, and who had sustained undetectable viral load ever since, had detectable HIV RNA (8 copies/ml) by ultrasensitive assay and HIV antibody and CD8+ T-cell responses to a broad range of HIV genes, indicating ongoing replication.

Dr Luzuriaga’s group suggested that these young people, like the acutely infected Thai patients described by Dr Ananworanich, could be “prime candidates for interventions to achieve functional cure or eradication.”

In contrast, data presented by collaborators from the University of Pittsburgh and Harvard University, show that in adults treated with fully suppressive antiretroviral therapy for at least ten years, but commenced in advanced HIV disease (median CD4 cell count 193 cells/mm3), HIV DNA declines during treatment, but remains detectable after ten years, with higher levels correlated with older age and higher baseline viral load. These findings suggest a much more well-established reservoir of HIV infection in chronically infected adults.

Offline Matts

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Re: HIV-Infected Infant Cured With Early Use of Virus-Blocking Drugs
« Reply #57 on: March 07, 2013, 07:57:07 pm »
Annie

My posting was too sloppy. I would never recommend a drug holiday.
There are some cases like the "Berlin Patient Number1" who could stay off ART after a treatment break.

The theory is, that immediate treatment after infection prevents the latent reservoirs and the virus can be cleared with ART. I think that's how PEP works. In our city the PEP is used nearly 600 times a year in three different hospitals, and as far as I read it always worked, when it was used within 72 hours.
 But more research is needed for this topic.
« Last Edit: March 07, 2013, 08:05:24 pm by Matts »
Dovato

Offline madbrain

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Re: HIV-Infected Infant Cured With Early Use of Virus-Blocking Drugs
« Reply #58 on: March 07, 2013, 09:24:47 pm »
PEP is NOT a 1-drug regimen. It's a two or more usual, a three drug regimen.

Sometimes people are only give Truvada, which is two drugs.


Sorry, my mistake. The one time that somebody I know had to use it, which was many years ago, it was not three drugs. I could have been two. I don't remember which one it was.

Offline madbrain

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Re: HIV-Infected Infant Cured With Early Use of Virus-Blocking Drugs
« Reply #59 on: March 07, 2013, 09:32:08 pm »
Develop characteristics not a changed genetic make up - meaning their ability to control the virus without HAART . If you define functional cure as a lack of viral replication with the absence of anti retroviral drugs, then they are functionally cured BUT for a limited period of time. I didn't say they were cured, or even functionally cured. And even elite controllers sometimes lose their ability to control the virus over time, losing the status when they do.

My point is that "Cured" and "for a limited period of time" are two antithetical terms.  You just can't use those terms together. You are simply using the wrong word.

Offline leatherman

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Re: HIV-Infected Infant Cured With Early Use of Virus-Blocking Drugs
« Reply #60 on: March 07, 2013, 09:37:00 pm »
There are some cases like the "Berlin Patient Number1" who could stay off ART after a treatment break.
The Berlin Patient Timothy Brown had a lot more happen than a treatment break. ::)

Besides, after you've been radiated and chemo-ed nearly to death then had your immune system totally replaced, basically eradicating the HIV in your system (not really "curing" you as a layman would think), would it really be called a treatment break to not be on meds anymore when there was no HIV in your new system? ???
leatherman (aka Michael)

We were standing all alone
You were leaning in to speak to me
Acting like a mover shaker
Dancing to Madonna then you kissed me
And I think about it all the time
- Darren Hayes, "Chained to You"

Offline Souledout

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Re: HIV-Infected Infant Cured With Early Use of Virus-Blocking Drugs
« Reply #61 on: March 07, 2013, 10:41:18 pm »
My point is that "Cured" and "for a limited period of time" are two antithetical terms.  You just can't use those terms together. You are simply using the wrong word.

Semantics. You know what I'm getting at, functional remission doesn't have the same ring to it.
Infection sometime April-August, no noticable seroconversion symptoms
Not currently on medication
13/09/12 CD4 672 (33%) VL <40 (diagnosis date)
18/09/12 CD4 ?               VL 43
27/09/12 CD4 ?               VL 127
19/11/12 CD4 676 (38%) VL 959
03/03/13 CD4 642 (32%) VL 291
04/07/13 CD4 791 (33%) VL 26,437 (active cold sore, tooth infection)
18/07/13 ------retest------VL 3704
18/11/13 CD4 802 (36%) VL 65

Offline Souledout

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Re: HIV-Infected Infant Cured With Early Use of Virus-Blocking Drugs
« Reply #62 on: March 07, 2013, 10:46:37 pm »
Thanks for all of the helpful information.  I sero-converted and went on meds at about the 6 week mark, my VL was at less thank 20K copies, and I went to UD almost immediately.  Over the course of the next year, I had a couple months where my VL rose to numbers still under 100 but detectable by today's standards.  I've been on ARV's now since November of 2011, and will continue to take, but hold out some "hope" now that maybe my choice to start meds immediately to preserve my immune system and stop any latent reservoirs was the right choice.  Maybe someday I can safely stop talking medication!  Until then, I am grateful for the medication I can get, and how well it works.

If your seroconversion illness was at the very end of August and you started treatment mid November that's over 10 weeks isn't it? Which is still very soon by all accounts.
Infection sometime April-August, no noticable seroconversion symptoms
Not currently on medication
13/09/12 CD4 672 (33%) VL <40 (diagnosis date)
18/09/12 CD4 ?               VL 43
27/09/12 CD4 ?               VL 127
19/11/12 CD4 676 (38%) VL 959
03/03/13 CD4 642 (32%) VL 291
04/07/13 CD4 791 (33%) VL 26,437 (active cold sore, tooth infection)
18/07/13 ------retest------VL 3704
18/11/13 CD4 802 (36%) VL 65

Offline Matts

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Re: HIV-Infected Infant Cured With Early Use of Virus-Blocking Drugs
« Reply #63 on: March 07, 2013, 11:41:03 pm »
The name "berlin patient" was confusing, I have to admit.
I meant the first one from 1996, Timothy Ray brown is here labelled as Number 2.:)

"In the history of AIDS, two men—both dubbed “the Berlin Patient”—will be remembered as harbingers in the quest for a cure.
The first Berlin Patient was a young German man who in 1996 sought care due to flu-like symptoms about three weeks after having unprotected sex. His doctor, Heiko Jessen, started him on ART and hydroxyurea, a cancer drug.
Hydroxyurea expert Franco Lori described the case at an AIDS conference in Hamburg in 1997. After starting combination therapy, the man rapidly reached an “undetectable” viral load according to an older test with a lower limit of 500 copies/mL. When he stopped his drugs a few months later due to a bout of hepatitis A, his HIV viral load stayed undetectable. About five
weeks later, he decided to permanently discontinue therapy and his virus remained suppressed.
This Berlin Patient was the first individual known to have achieved “remission” of HIV, and the case made headlines around the world, including a profile in the New York Times Magazine. Lori’s team presented further details at CROI 1999 and in the May
27, 1999, New England Journal of Medicine. By that time, Berlin Patient #1 had been off treatment for about two years, still with
no plasma viral rebound. But traces of HIV RNA were detected in his lymph nodes, and replication-competent virus was isolated from a small number of resting CD4 T-cells after Robert Siliciano developed a sensitive test.
Although his HIV was not eradicated, the man’s immune system managed to control the virus, demonstrating that a functional cure is within the realm of possibility. “I’ve never met him, and I don’t even know his name, but I’ve followed his case,” a member of an HIV positive support group told journalist Mark Schoofs. “He is what we want to be.
The second Berlin Patient came to the world’s attention a decade later. An American man living in Germany, he underwent
treatment for acute myeloid leukemia at Berlin’s Charité Medical University in 2006........" (Page 20)
(The rest is known).


I think the source is a good read about HIV latency:

http://www.sfaf.org/hiv-info/hot-topics/beta/2011-beta-winterspring-eradication.pdf

Dovato

Offline Souledout

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Re: HIV-Infected Infant Cured With Early Use of Virus-Blocking Drugs
« Reply #64 on: March 08, 2013, 05:39:20 am »
So, the long and short of it is that I'm moving to Berlin.
Infection sometime April-August, no noticable seroconversion symptoms
Not currently on medication
13/09/12 CD4 672 (33%) VL <40 (diagnosis date)
18/09/12 CD4 ?               VL 43
27/09/12 CD4 ?               VL 127
19/11/12 CD4 676 (38%) VL 959
03/03/13 CD4 642 (32%) VL 291
04/07/13 CD4 791 (33%) VL 26,437 (active cold sore, tooth infection)
18/07/13 ------retest------VL 3704
18/11/13 CD4 802 (36%) VL 65

Offline mecch

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Re: HIV-Infected Infant Cured With Early Use of Virus-Blocking Drugs
« Reply #65 on: March 08, 2013, 07:51:36 am »
Hey thanks. I never heard of that first Berlin Patient...

________________

Throwing this out there.....   Maybe everyone identified in seroconversion should be advised to start treatment...  Maybe we are missing some opportunities here to create at least some LTNPs or functional cures in adults...  All the results that are not spectacular, will still result in HIV+ people who only had a month or two of detectable viral load in their lives....  But a guess a wrench in this pipe dream is that the infection might be with a strain that requires a certain combo, so quick identification of that would be required, as well...
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline leatherman

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Re: HIV-Infected Infant Cured With Early Use of Virus-Blocking Drugs
« Reply #66 on: March 08, 2013, 09:13:40 am »
Hey thanks. I never heard of that first Berlin Patient...
all these yrs and I never heard of this patient #1 either; but here are some more links
http://www.nytimes.com/1998/06/21/magazine/the-berlin-patient.html?pagewanted=all&src=pm
http://www.investorvillage.com/smbd.asp?mb=1933&mn=48657&pt=msg&mid=12415426
http://ksj.mit.edu/tracker/2011/02/updated-and-amended-bloomberg-berlin-pat

what I'm wondering, but not seeing, is what happened with patient #1? The original story is from 1998; but I didn't find any follow up to this story. Which seems very weird. What I did find was that Mark Schoof's was the first to report on BOTH berlin patients (http://www.nytpick.com/2008/11/times-takes-on-wsjs-aids-scoop-and.html). which seems weird too.

does anyone have any more info about patient#1??
leatherman (aka Michael)

We were standing all alone
You were leaning in to speak to me
Acting like a mover shaker
Dancing to Madonna then you kissed me
And I think about it all the time
- Darren Hayes, "Chained to You"

Offline Tadeys

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Re: HIV-Infected Infant Cured With Early Use of Virus-Blocking Drugs
« Reply #67 on: March 08, 2013, 09:27:33 am »
His doctor, Heiko Jessen, started him on ART and hydroxyurea, a cancer drug.


Hydroxyurea...hummmmmmmm.

Offline idee

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Re: HIV-Infected Infant Cured With Early Use of Virus-Blocking Drugs
« Reply #68 on: March 09, 2013, 12:32:37 am »
To me it is a game changer. To get to number 40 million you must pass number 2 first.

Best

I like that saying.

Offline idee

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Re: HIV-Infected Infant Cured With Early Use of Virus-Blocking Drugs
« Reply #69 on: March 09, 2013, 12:38:45 am »
My mom told me about this and she watches the news on hiv closer than I do. I hope these cures lead to a cure for the rest of us.

Offline idee

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Re: HIV-Infected Infant Cured With Early Use of Virus-Blocking Drugs
« Reply #70 on: March 09, 2013, 12:43:10 am »
all these yrs and I never heard of this patient #1 either; but here are some more links
http://www.nytimes.com/1998/06/21/magazine/the-berlin-patient.html?pagewanted=all&src=pm
http://www.investorvillage.com/smbd.asp?mb=1933&mn=48657&pt=msg&mid=12415426
http://ksj.mit.edu/tracker/2011/02/updated-and-amended-bloomberg-berlin-pat

what I'm wondering, but not seeing, is what happened with patient #1? The original story is from 1998; but I didn't find any follow up to this story. Which seems very weird. What I did find was that Mark Schoof's was the first to report on BOTH berlin patients (http://www.nytpick.com/2008/11/times-takes-on-wsjs-aids-scoop-and.html). which seems weird too.

does anyone have any more info about patient#1??

Are you talking about Timothy Ray Brown? He is the one guy who was cured of HIV and cancer with a bone marrow transplant in Berlin.  http://www.youtube.com/watch?v=6Uf0ypNHz0E

Offline Miss Philicia

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Re: HIV-Infected Infant Cured With Early Use of Virus-Blocking Drugs
« Reply #71 on: March 09, 2013, 01:34:27 am »

Hydroxyurea...hummmmmmmm.

hmmm what? I took that vile drug myself back in the early 90's when there were only two HIV meds available. Possible bone marrow toxicity, anemia, stomatitis, etc.  the list goes on as far as possibilities.
"I’ve slept with enough men to know that I’m not gay"

Offline leatherman

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Re: HIV-Infected Infant Cured With Early Use of Virus-Blocking Drugs
« Reply #72 on: March 09, 2013, 01:52:41 am »
Are you talking about Timothy Ray Brown? He is the one guy who was cured of HIV and cancer with a bone marrow transplant in Berlin.  http://www.youtube.com/watch?v=6Uf0ypNHz0E
nope. this is a whole different guy. A "berlin patient" in 1998. He was supposedly treated earlier in his infection, the hiv seemed to go into remission..... and then I can't find anything else about him. which really doesn't bode well. You'd think if he had been "cured", even as a functional cure, there would be more follow-up all these yrs later. It seems like you've been just as in the dark as I have been about this guy, this "berlin patient #1"

it turns outs our that Tim Brown is actually "berlin patient #2" - but with a completely different situation.

here's the story, as told in that second link I posted:
Quote
Two Berlin Patients
This Berlin Patient was the first individual known to have achieved “remission” of HIV, and the case made headlines around the world, including a profile in the New York Times Magazine. Lori’s team presented further details at CROI 1999 and in the May 27, 1999, New England Journal of Medicine. By that time, Berlin Patient #1 had been off treatment for about two years, still with no plasma viral rebound. But traces of HIV RNA were detected in his lymph nodes, and replication-competent virus was isolated from a small number of resting CD4 T-cells after Robert Siliciano developed a sensitive test.

Although his HIV was not eradicated, the man’s immune system managed to control the virus, demonstrating that a functional cure is within the realm of possibility. “I’ve never met him, and I don’t even know his name, but I’ve followed his case,” a member of an HIV positive support group told journalist Mark Schoofs. “He is what we want to be.”

The second Berlin Patient came to the world’s attention a decade later. [this is Mr. Brown, Idee ;) ]An American man living in Germany, he underwent treatment for acute myeloid leukemia at Berlin’s Charité Medical University in 2006. At that time, he had been HIV positive for more than ten years and on ART for four years, and had undetectable viral load. But he had a history of high viral load and disease progression, so was not a natural elite controller.
http://www.investorvillage.com/smbd.asp?mb=1933&mn=48657&pt=msg&mid=12415426

started him on ART and hydroxyurea, a cancer drug.
Hydroxyurea...hummmmmmmm.
hmmmm, AZT was a cancer drug too. ;) ::)
leatherman (aka Michael)

We were standing all alone
You were leaning in to speak to me
Acting like a mover shaker
Dancing to Madonna then you kissed me
And I think about it all the time
- Darren Hayes, "Chained to You"

Offline Larsen

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Re: HIV-Infected Infant Cured With Early Use of Virus-Blocking Drugs
« Reply #73 on: March 09, 2013, 10:41:35 am »
The thing to remember about 1996, which is when this thing with the German guy is supposed to have happened, was that triple drug therapy was the new buzz and Time magazine was naming David Ho their 'Man of the Year' for declaring that it could totally eradicate HIV from the body within 18 to 36 months of therapy commencing. It was the optimistic high that popped and made the 'cure' pretty much taboo for another decade.

I am guessing that this patient #1 just turned out to be another of the however many thousand long-term nonprogressors (remembering here that the CCR5-Δ32 mutation is by far and away at its most common amongst ethnic Germans and Nordics).
« Last Edit: March 09, 2013, 10:47:24 am by Larsen »
In a far better p[lace than this minging shithole

Offline vaboi

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Re: HIV-Infected Infant Cured With Early Use of Virus-Blocking Drugs
« Reply #74 on: March 10, 2013, 06:23:50 am »
I am baffled behind the science of all of this, but wonder if an adult went on ARV very soon after sero-conversion happened, within say a month and the viral load taken at that time was under 100,000 is this same scenario even somewhat likely for that person?  To me that's a breakthru if it's the case.

I'm one of these people.  I started ARV three weeks after likely infection.  However my VL was much higher than 100k since I was in seroconversion at the time.  When I went to the doc office, I was so sure the "flu-like" symptoms were from HIV that I insisted they give me a VL test over the antibody test, which they finally agreed to once they ruled out mono or any other cause.  If I only knew what I knew today, I would have insisted on beginning meds at that moment and I could have started 1 week after the event.   But it's now been 3 years for me and I'm not about to stop ARV just to "test" whether VL stays low for awhile.  I'd rather take them for 10 more years and maybe by then I will really be cured.   Who knows...

 


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