HIV vs. AIDS again
Posted: Jul 7, 2002
QUESTION:
Hello Dr Young, On a previous posting at TheBody.com (HIV vs AIDS, 25 July 2001), you said that once someone's immune system has recovered (where that person has been diagnosed as having AIDS), for all intents and purposes, they are more or less in the same situation as someone who is just diagnosed as having HIV and whose immune system has not collapsed or suffered from an OI. However, is it not the case that people who have been diagnosed as having AIDS and on HAART, can expect a life expectancy of 15-20 years? In other words, even though an AIDS patient might have a reconstituted immune system, there is a real difference in possible life expectancy outcome. Isn't there also debate about the quality of the CD4 cells that are newly manufactured where someone's immune system has previously collapsed? Your answer would be most appreciated.
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RESPONSE FROM: 
Thanks for your questions and comments.
You accurately summarize some of the uncertanties of the natural history of HIV following antiretroviral therapy.
It is very difficult to compare the life expectancies between people who have had successful reconstitution of the immune system with those who never had severe immunodepletion, since the total time of HIV infection is different among the two groups. In either case, we can only place a lower estimate of life expectancy; I think that it is reasonable to expect that life expectancy will improve for both groups over time.
You are also correct in the statement that there is debate over the quality of CD4 cells (immune function) after immune reconstitution. Clearly T cell receptor diversity is decreased after reconstitution (compared with equivalent, non-declined T cell levels). This data raises concern about delayed therapy. On the other hand, the clinical data about immune function- as measured by risk for recurrence or occurrence of PCP or MAI infection would suggest that the risk for these infections decreases once reconstituted CD4 cell levels reach the very levels at which one became at risk.
BY
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