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Author Topic: long term effects of untreated HIV with good numbers  (Read 3120 times)

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Offline texaninnyc87

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  • Posts: 247
long term effects of untreated HIV with good numbers
« on: January 31, 2013, 08:01:05 PM »
sorry if im posting too much but I'm very curious about this.

i mentioned in another post about this support group ive been going to. it's for newly diagnosed gay 20 somethings. the group is full of...characters. it goes without saying that in a group full of young gay men some bickering and arguments are inevitable at some point.

this one guy, different than the one i posted about before, went off on this rant today about how EVERYONE who is positive has to be on medication, regardless of your counts. he kept going on about the long term effects of HIV on the body and how it "ages you 50 years" and about diabetes and heart problems and all these other conditions that are inevitable if you are not on meds, regardless of your numbers. this rant was in response to a 23 year old who was diagnosed a year ago who was debating starting meds. this 23 year old has never had a cd4 count under 700 and has a viral load that has fluctuated but has been around 1000 for the past few months.

this seems wrong to me. being the know it all that i am, i asked him what research he was referring to and gave him my two cents on the matter based on my admittedly limited knowledge. i explained to him what an elite controller was and told him that some people can live decades without medication with little to no negative impact on their body. i told him that, from what i know, as long as your cd4 counts are high and your viral load is low there isn't really a need to start medication right away unless the person is worried about getting undetectable so they can minimize the risk of transmission. from everything i've read, if you live a healthy life and you are either an elite controller or someone who is newly infected there is very little risk of adverse long term effects on your health. he seemed to think that you could catch a bad cold and suddenly your tcells would plumet and you would have AIDS. he also said all this stuff about HIV "eating your brain" no matter what your viral load.

am i completely off base here? i wanted to stand up for this kid (the 23 year old) he has a very resistant strain and doesn't feel stable enough with his life style to begin meds. since his numbers are good i thought it would probably be better for him to wait until meds are necessary so that he would be better equipped for the lifestyle change they will entail. i thought this was especially important since he had so many resistance issue because if he messes up his adherence he'll have even LESS options.

so im wondering if there actually is any proof to support what this guy was saying, if so I guess i'm just a know-it-all asshole, which wouldnt shock me. Is there any research to show that there is damage done to elite controllers simply from being positive,e ven if they have good numbers? i know i read a study that noted the average life expectancy for people starting meds based on their t-cell counts when they begin treatment. according to this study, people with high counts actually have a slightly lower life expectancy than those who begin treatment in the 300 range...
Dxd: 9/11/12
Blot confirmed: 11/12
12/12 cd4: 280 (20%) vl: 129,000
1/13 $tribild
2/13 cd4: 350 (26%) vl: 80
4/13 cd4: 510 (29%) vl:: 35
6/13cd4 350 (31%) vl: 21
9/13 cd4 492 (30%) vl: ud
12/13 cd4 846 (36%) vl: 100
1/14 cd4 480 (31%) vl: UD
3/14 cd4 650 (33%) vl: UD
6/14 cd4 410 (35%) vl: UD
9/14 cd4 439 (38%) vl: UD

Offline buginme2

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Re: long term effects of untreated HIV with good numbers
« Reply #1 on: January 31, 2013, 10:52:28 PM »
Your both right.
 
Don't be fancy, just get dancey

Offline Dr.Strangelove

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  • Posts: 214
Re: long term effects of untreated HIV with good numbers
« Reply #2 on: January 31, 2013, 11:40:41 PM »
I'd say you are right and he is wrong. I think there is no clear evidence (yet?) that people with CD4>500 benefit from early treatment.

Quote
The recommendation to initiate therapy at CD4 count >500 cells/mm3 is based on growing awareness that untreated HIV infection or uncontrolled viremia may be associated with development of many non-AIDS-defining diseases, including cardiovascular disease (CVD), kidney disease, liver disease, neurologic complications, and malignancy; availability of ART regimens that are more effective, more convenient, and better tolerated than earlier ART combinations no longer widely used; and evidence from one observational cohort study that showed survival benefit in patients who started ART when their CD4 counts were >500 cells/mm3.

Tempering the enthusiasm to treat all patients regardless of CD4 count is the absence of randomized data that definitively demonstrate a clear benefit of ART in patients with CD4 count >500 cells/mm3 and mixed results on the benefits of early ART from observational cohort studies. In addition, potential risks of short- or long-term drug-related complications and nonadherence to long-term therapy in asymptomatic patients may offset possible benefits of earlier initiation of therapy. When resources are not available to initiate ART in all patients, treatment should be prioritized for patients with the lowest CD4 counts and those with the following clinical conditions: pregnancy, history of an AIDS-defining illness, HIV-associated nephropathy (HIVAN), or HIV/hepatitis B virus (HBV) coinfection.

link

Offline tednlou2

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Re: long term effects of untreated HIV with good numbers
« Reply #3 on: January 31, 2013, 11:44:09 PM »
I don't have studies.  I have read articles that say long term infection creates holes in the immune system.  And, your CD4s may not be as strong.  They were saying a poz person with a CD4 of 800 not on meds, for example, may not be as protected as one would think.  An illness could wipe out those CD4s, because they aren't as strong as the number would suggest.  But then I read where many aren't sure whether there is a benefit from starting higher than 500. 

There are those who are big on starting meds right away.  I have gotten private messages from some.  I get them every month or so.  They ask whether I started meds yet.  If not, why not?  When I say I am still waiting, they will list all the reasons why I should.  I do believe they have all the best intentions.  And, they may be right.  I believe I am at the least in my 12 year of infection.  I know uncontrolled infection cannot be good for that long.  My CD8 levels are often up near 2,000.  While that is seen as a good thing in being able to control the virus, it is also seen as a bad thing, due to immune activation and inflammation. 

So, while the high-pressure tactic isn't always helpful, especially for a young person infected just a year with good labs, I am not sure the view is totally off base.  Having said that, the guy you mention is still new to all this and I am sure still coming to terms with it.  I do not think he should be pressured, or made to feel he is making a huge mistake.  I think this is a debate for those with longer infections.  It will be interesting to hear from those who know their stuff.

Offline Dr.Strangelove

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  • Posts: 214
Re: long term effects of untreated HIV with good numbers
« Reply #4 on: January 31, 2013, 11:49:52 PM »
Quote
I have read articles that say long term infection creates holes in the immune system.  And, your CD4s may not be as strong.  They were saying a poz person with a CD4 of 800 not on meds, for example, may not be as protected as one would think.  An illness could wipe out those CD4s, because they aren't as strong as the number would suggest.
This part makes no sense to me at all. There is no such thing as weak or strong CD4 cells and the 'hole' that the virus creates in the immune system is - well - the reduced number of CD4 cells, since that is the only type of cells the virus can enter.

If you find a link to that article, please post it. Thanks

Offline jkinatl2

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  • Doo. Dah. Dipp-ity.
Re: long term effects of untreated HIV with good numbers
« Reply #5 on: February 01, 2013, 12:18:07 AM »
"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline buginme2

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  • Posts: 3,200
Re: long term effects of untreated HIV with good numbers
« Reply #6 on: February 01, 2013, 12:31:49 AM »
Here: Dr Sax (From Harvard and Bringham and Womens in Boston) Blogs about:

"Warning: Viral Replication is Hazardous to Your Health"

Take away from the article:The take-home message from this skillfully done study is that viral replication is bad for your health even if your CD4-cell count is OK.  And why might this be the case?  The authors write:
 

We speculate the number of viremia copy-years, as a measure of cumulative plasma HIV burden, serves as a surrogate for and perhaps is the underlying driver of cumulative inflammation and immune system activation that approximates such long-term inflammatory biomarker effects


http://blogs.jwatch.org/hiv-id-observations/index.php/warning-viral-replication-is-hazardous-to-your-health/2011/09/24/

He also links to another study that lists time of uncontrolled viral replication to an increased risk of lymphoma.

 the bottom line according to Sax:

So even though we are unlikely to start using this viremia copy-years value in clinical practice, these data certainly make intuitive sense and reinforce the notion that getting this lethal virus under control is the logical way to improve outcomes
« Last Edit: February 01, 2013, 12:37:03 AM by buginme2 »
Don't be fancy, just get dancey

Offline Dr.Strangelove

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  • Posts: 214
Re: long term effects of untreated HIV with good numbers
« Reply #7 on: February 01, 2013, 12:54:37 AM »
Quote
We speculate...
That's the point. So far this is just a theory. They may well be right but it hasn't been backed up with studies yet.

If there was a study that shows clear benefits of an early start of treatment I think we wouldn't have the recommendation of a threshold of 500 (or 350). They would just put everyone on meds right away.

Coming back to the original post:
Quote
... about how EVERYONE who is positive has to be on medication, regardless of your counts. he kept going on about the long term effects of HIV on the body and how it "ages you 50 years" and about diabetes and heart problems and all these other conditions that are inevitable if you are not on meds, regardless of your numbers.
Do the elite controllers age by 50 years, get diabetes and heart problems? Any studies on that? Or anecdotes? (Would love to know if Ann looks like her age plus an additional 50 years. ;D )

Online Miss Philicia

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  • celebrity poster, faker & poser
Re: long term effects of untreated HIV with good numbers
« Reply #8 on: February 01, 2013, 01:06:08 AM »
The two long term non-progressors that I personally know do not look older than their actual age. If anything they look younger. Nor have they had any unusual health issues.
"Ive slept with enough men to know that Im not gay"

Offline friskyguy

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  • Posts: 109
Re: long term effects of untreated HIV with good numbers
« Reply #9 on: February 01, 2013, 01:12:01 AM »
We all still focus almost exclusively on CD4 counts as a measure of our health. Sure CD4 counts are important......but heh news flash!!......for those not on meds the virus is also actively replicating uncontolled in macrophages and in other cells in the body.....virus in these cells that we don't normally follow or test until its too late! Oh yeah and dont get me started on uncontrolled replication in the the CNS too and news flash again......the viral load levels in the CNS don't necessarily match those levels in the blood!

Its well known that the virus replicates in these other body compartments killing us softly!......inflammation anyone?.....and we again don't normally test for this until its too late.....HAND anyone? No thank you!

As the experts increasingly improve the understanding of the effects of HIV on our bodies, the pendulum is indeed swinging in the 'start now position' especially with better and more tolerable meds on the market!

Being sexually active, and seeing the definite movement of the pendulum it was a no brainer for me to protect my long term health by commencing with meds (especially with high penetration in the CNS) and to protect the health of my partner/s as well.

For those happily content with their non-meds status quo, just keep on monitoring those CD4 cells and viral load in one's blood! Hey everyone has a choice!
Sero converted Sept '10 / Confirmed + Dec '10
Jan '11, VL 9,500 / CD4 482 (32%)
Feb '11, VL 5,800 / CD4 680 (37%)
start Atripla
Mch '11, VL UD / CD4 700 (42%)
Jun  '11, VL UD / CD4 750 (43%)
swap to Kivexa and Efav. due to osteopenia diag. (DEXA) / kidney issues ( decline in eGFR to 77 )
start supplements - Vit D3 / Omega 3 / multivitamin / mini aspirin
Dec '11,  VL UD <20 /  CD4 670 (49%)  / CD4:CD8 = 1.4
all labs now within normal ranges
Mch '12,  VL UD / CD4 600 (51%)
Sep '12,  VL UD / CD4 810 (51%)
Mch '13   VL UD / CD4 965 (56%)
Sep '13   VL UD / CD4 (not taken)
Dec '13   VL UD / CD4 901 (35%) / CD4:CD8 = 1.1  /  eGFR > 100

Offline tednlou2

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  • Posts: 5,049
Re: long term effects of untreated HIV with good numbers
« Reply #10 on: February 01, 2013, 01:12:45 AM »
Here's just one example.  Are you saying HIV only reduces the number of CD4 cells, but has no effect on how they function?  I said I was just relaying info from articles I've read.  I've read several that say the virus creates holes in the immune system.  You may look great on paper, but your cells aren't the same as someone neg or even someone on meds.  I will try to find the specific article that discussed CD4 cells in those treatment naive and how they may not function as well, after years of untreated infection. 


"Along with the fall in numbers, there are profound changes in CD4 cell function, first revealed in the late 1980s by immunologist Gene Shearer and colleagues at the National Institutes of Health. Shearer demonstrated what can best be described as a spreading dysfunction among CD4 cells over the course of HIV infection."


http://www.thebody.com/content/art14210.html

Offline friskyguy

  • Member
  • Posts: 109
Re: long term effects of untreated HIV with good numbers
« Reply #11 on: February 01, 2013, 01:25:48 AM »
Not all CD4 cell are created equally!!! Wow great article....thanks
Sero converted Sept '10 / Confirmed + Dec '10
Jan '11, VL 9,500 / CD4 482 (32%)
Feb '11, VL 5,800 / CD4 680 (37%)
start Atripla
Mch '11, VL UD / CD4 700 (42%)
Jun  '11, VL UD / CD4 750 (43%)
swap to Kivexa and Efav. due to osteopenia diag. (DEXA) / kidney issues ( decline in eGFR to 77 )
start supplements - Vit D3 / Omega 3 / multivitamin / mini aspirin
Dec '11,  VL UD <20 /  CD4 670 (49%)  / CD4:CD8 = 1.4
all labs now within normal ranges
Mch '12,  VL UD / CD4 600 (51%)
Sep '12,  VL UD / CD4 810 (51%)
Mch '13   VL UD / CD4 965 (56%)
Sep '13   VL UD / CD4 (not taken)
Dec '13   VL UD / CD4 901 (35%) / CD4:CD8 = 1.1  /  eGFR > 100

Offline jkinatl2

  • Member
  • Posts: 6,007
  • Doo. Dah. Dipp-ity.
Re: long term effects of untreated HIV with good numbers
« Reply #12 on: February 01, 2013, 01:53:35 AM »
I find myself in an odd position, since I personally am all for treatment upon diagnosis.

However, I also think that a person NEEDS to be in a place where s/he can commit to a drug regimen that could possibly be a lifetime thing. Without that certainty, it really doesn't matter what other numbers indicate, does it? And with HIV losing relevance, even among infected people, how can this regimen, which offers at least a passing interference with a person's life (side effects, insurance/ADAP, et al) be stressed as important/necessary. Especially in the absence of direct HIV-related impact?

So I ask- Where are the studies that indicate that long term slow progressors (which was the intent of the OP, I believe) have a pressing need to be on medication? I will never argue that there is no benefit. I am just wondering why the need, rather than why the desire?

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline friskyguy

  • Member
  • Posts: 109
Re: long term effects of untreated HIV with good numbers
« Reply #13 on: February 01, 2013, 02:19:58 AM »

So I ask- Where are the studies that indicate that long term slow progressors (which was the intent of the OP, I believe) have a pressing need to be on medication? I will never argue that there is no benefit. I am just wondering why the need, rather than why the desire?



For some and again their free choice, they will only start meds upon the signed off and delivered green light to do so........i believe START will help those in this regard......in how many more years now  ::)
Sero converted Sept '10 / Confirmed + Dec '10
Jan '11, VL 9,500 / CD4 482 (32%)
Feb '11, VL 5,800 / CD4 680 (37%)
start Atripla
Mch '11, VL UD / CD4 700 (42%)
Jun  '11, VL UD / CD4 750 (43%)
swap to Kivexa and Efav. due to osteopenia diag. (DEXA) / kidney issues ( decline in eGFR to 77 )
start supplements - Vit D3 / Omega 3 / multivitamin / mini aspirin
Dec '11,  VL UD <20 /  CD4 670 (49%)  / CD4:CD8 = 1.4
all labs now within normal ranges
Mch '12,  VL UD / CD4 600 (51%)
Sep '12,  VL UD / CD4 810 (51%)
Mch '13   VL UD / CD4 965 (56%)
Sep '13   VL UD / CD4 (not taken)
Dec '13   VL UD / CD4 901 (35%) / CD4:CD8 = 1.1  /  eGFR > 100

Offline Rockin

  • Member
  • Posts: 494
Re: long term effects of untreated HIV with good numbers
« Reply #14 on: February 01, 2013, 05:58:24 AM »
When I was diagnosed I had AIDS (CD4 was at 280 or something) so I didn't have much choice. However, I do feel better knowing that I am being protected by the HAART treatment. If I wasn't UND and all of a sudden I had the flu or something I would probably freak out about it.

One question though: some doctors claim that HAART can age you faster. Others claim that HIV going wild in your body can age you faster.

Is there any evidence to either of those claims?

Offline Common_ground

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  • Posts: 288
Re: long term effects of untreated HIV with good numbers
« Reply #15 on: February 01, 2013, 06:22:58 AM »
Re: HAART can age you faster

This article came out yesterday.

http://www.aidsmap.com/Tenofovir-impairs-enzyme-that-stops-cells-ageing/page/2567149/

There is a lot of ifs and maybes here but it seems particularly tenofovir (In Truvada, Atripla etc.) could have an impact on something in our DNA making us age faster.

I cant really understand the findings from this research and what implications it might have but maybe someone else with a medical background (or just more literate than me  ::)) could take a jab?

Mod. for spelling
2011 May - Neg.
2012 June CD4:205, 16% VL:2676 Start Truvada/Stocrin
2012 July  CD4:234, 18% VL:88
2012 Sep  CD4:238, 17% VL:UD
2013 Feb  CD4:257, 24% VL:UD -viramune/truvada
2013 May CD4:276, 26% VL:UD

Offline Growler

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  • Posts: 567
Re: long term effects of untreated HIV with good numbers
« Reply #16 on: February 01, 2013, 09:27:11 AM »
cd4 520 low3st 440?
I had neurosyphis and hivn in brain.
treatted neurosyphlis but hiv still there damaging still. no haart (just 2 weeks atripe  ) but ifstarted sooner no damage but stopped sooner becuseofp roblems. STart soon as you can!!

GROWLER


If loving someone is putting them in a straitjacket and kicking them down a flight of stairs, then yes, I have loved a few people.

Offline Dr.Strangelove

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  • Posts: 214
Re: long term effects of untreated HIV with good numbers
« Reply #17 on: February 01, 2013, 12:10:28 PM »
Don't get me wrong. Personally, I am all for an early treatment start.
The only reason I am not on meds yet (despite my good numbers) is because I was living abroad and had issues with health insurance which are now sorted out.
I think most people want to delay the treatment start just because they are scared of the meds and their side effects. But sooner or later we all have to start, so what's the point in waiting and watching those CD4s drop.
I also believe that there would be a lot less new infections if everyone would get  tested and treated right away.

Anway, that's just my opinion. The question of the OP was if there is a scientific basis of the claims of that guy (such has accelerated aging for people who are not on meds but have good numbers) and I think the answer to that question is: no

Offline Rockin

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  • Posts: 494
Re: long term effects of untreated HIV with good numbers
« Reply #18 on: February 01, 2013, 12:15:35 PM »
But then again, every doctor out there claims that drugs and alcohol will definitely make you age faster...and then I look at Charlie Sheen and he seems to be looking good for his age.

Offline newt

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  • the one and original newt
Re: long term effects of untreated HIV with good numbers
« Reply #19 on: February 01, 2013, 02:31:29 PM »
Basically, the ranter is wrong to be so strong.

There are two issues here, the benefits of treatment, and  untreated HIV and it's effects on the body,

The benefits, ie reduced risk of death or illness, are strongly demonstrated if you start treatment at a CD4 count of 350-500. This is pretty much accepted worldwide.

Above, 500, well, even though American guidelines went for treatment for all in this position, it is a position with some caveats, and not supported elsewhere, eg in the UK and Europe, at WHO. There is no really good study to support the idea that treatment at a CD4 count above 500 makes more than a marginal difference to the risk of illness or death.

Whether for someone with a normal-level CD4 count and low viral load eg 1,000 like the guy mentioned here, would derive benefit from treatment can be fairly called either way.

But there is whole bunch of other stuff which suggests that treatment regardless of CD4 count may help. For one there is persuasive evidence about treatment reducing inflammation, which is a good thing, for this contributes to risk of cancer, hearth disease etc. And persuasive stuff about untreated HIV possibly affecting your cognition and digestive health.

Obviously, too, the reduction in risk of transmission from a suppressed viral load is a benefit of immediate treatment to bear in mind.

The effect of untreated HIV on the body, this is an interesting area to look at, and there is some fair science, but strong and outlandish statements like HIV ages you 50 years are unjustified. It undoubtedly has some effect, probably akin to smoking says my doctor, and therefore like smoking something with a wide range of impact that depends on a lot of other factors, including your genetics and lifestyle.

The problem with the research in this area is that none of it is robust enough to conclusively separate HIV from other possible causes. For example, if you see reduced cognitive function in people with HIV is it because the people drink, took drugs a while back or the HIV? It's a complicated area to study.

It is also possible that the worst effects of HIV on your body's immunity are done in the first few weeks of infection. Treatment long term (5+ years) may for the most part reverse this. Therefore, unless you catch HIV in the very earliest stages of having it, the above 500, below 500 discussion is a bit late.

Hope this helps.

- matt
"The object is to be a well patient, not a good patient"

Offline texaninnyc87

  • Member
  • Posts: 247
Re: long term effects of untreated HIV with good numbers
« Reply #20 on: February 01, 2013, 04:03:33 PM »
Lots of good info here. Very interesting. I guess the bottom line is that we were both kind of right and theres no real conclusive data either way.
Dxd: 9/11/12
Blot confirmed: 11/12
12/12 cd4: 280 (20%) vl: 129,000
1/13 $tribild
2/13 cd4: 350 (26%) vl: 80
4/13 cd4: 510 (29%) vl:: 35
6/13cd4 350 (31%) vl: 21
9/13 cd4 492 (30%) vl: ud
12/13 cd4 846 (36%) vl: 100
1/14 cd4 480 (31%) vl: UD
3/14 cd4 650 (33%) vl: UD
6/14 cd4 410 (35%) vl: UD
9/14 cd4 439 (38%) vl: UD

Offline elf

  • Member
  • Posts: 617
Re: long term effects of untreated HIV with good numbers
« Reply #21 on: February 01, 2013, 06:37:36 PM »
Re: HAART can age you faster

This article came out yesterday.

http://www.aidsmap.com/Tenofovir-impairs-enzyme-that-stops-cells-ageing/page/2567149/

There is a lot of ifs and maybes here but it seems particularly tenofovir (In Truvada, Atripla etc.) could have an impact on something in our DNA making us age faster.

I cant really understand the findings from this research and what implications it might have but maybe someone else with a medical background (or just more literate than me  ::)) could take a jab?

Mod. for spelling


That's why I take melatonin:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3549369/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001216/


Quote
During the natural history of human immunodeficiency virus type I (HIV-1) infection, an impairment of IL-12 production precedes a switch from a Th-1 to a Th-2 stage of cellular immunity. A recent study indicated a correlation of serum levels of melatonin and IL-12 in a cohort of 77 HIV-1 infected individuals, the decreased levels of serum melatonin found in HIV-1-infected individuals being possibly instrumental in the impairment of Th-1 immune response
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1325257/
« Last Edit: February 01, 2013, 06:42:41 PM by elf »

 


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