SEPTEMBER 1998

NUMBER ONE

HIV-Related Illnesses
Don't let opportunistic infections sneak up on you.

Opportunistic infections (OIs) are illnesses that develop when the immune system is weakened due to HIV activity. After exposure to HIV, individuals typically develop transient, flu-like symptoms lasting two weeks; a prolonged fever may be a predictor of rapid disease progression. Many years may pass before other symptoms develop, but in time, HIV usually gains an edge over the immune system and leaves the body vulnerable to disease.

New studies presented at the recent Geneva World AIDS Conference continue to show that three-drug combination HIV therapy greatly reduces one's risk of developing OIs, especially PCP, MAC and CMV. This news has also caused a shift in the way experts view the role of prophylaxis, or prevention, and therapy. Many reports at Geneva showed HAART boosts im-mune responses and function in many individuals, even those with advanced disease, although not fully. But across the spectrum, the incidence of most OIs has declined dramatically in people on successful HAART regimens. The important exceptions are non-Hodgkin's lymphoma (NHL). Other infections like hepatitis and human papilloma virus (HPV) continue to crop up in individuals on HAART therapy with very low T-cells or advanced disease.

In general, healthy people with over 500 T-cells are considered at low risk for developing OIs. HIV prophylaxis is still recommended when T-cells drop below 200. But, experts are hotly debating whether a subset of individuals on HAART with a high, stable T-cell count might be able to stop PCP and MAC prophylaxis.

Several large-scale studies presented there show it's possible to predict the risk of getting an OI after three months on HAART therapy using a 200 T-cell count as the cut-off point. A persistent low T-cell count of 200 or below after three months on HAART is linked to a risk of developing an OI- regardless of whether one has a detectable HIV viral load or is below the level of detection, say experts, who recommend that these individuals continue prophylactic therapy.

But an individual whose T-cell count at three months is over 200 appears unlikely to progress, say experts, even if their viral load (HIV RNA) is still detectable. For these people, stopping prophylaxis may be a future option with close monitoring by a doctor. For now, federal guidelines haven't changed. But studies have begun to analyze these early trends. It's also important to keep in mind that there's still a risk of developing OIs if a drug regimen fails or HIV resistance develops, may cause HIV to rebound and lower T-cell levels. Tip: Discuss these developments with your doctor or an HIV specialist before considering any changes in prophylactic therapy.