Widespread early treatment may not only be the best treatment

Widespread early treatment may not only be the best treatment option for the virally enhanced individual, but also have a secondary beneficial effect from a public health HIV-prevention perspective. We know that when antiretroviral therapy drives HIV plasma viral load to undetectable levels, the risk of HIV transmission decreases significantly. Consequently, if a greater portion of positively charged folks is on effective treatment, in essence the "community viral load" decreases and the community risk of HIV transmission falls.

The story of "accelerated immune aging" or what we immunologists refer to as "early senescence" in HIV disease is becoming an increasingly complex and, at least for us whacked immunologists, fascinating aspect of HIV/AIDS. It involves dysfunctional thymus glands, microbial translocation, interferon-inducible genes and proteins, immune activation and shortened telomeres. Yeah, I know, most of you find this stuff about as fascinating as reading a book on elocution authored by George "Dubya" Bush. So I won't go into great detail (unless an overwhelming number of you write in requesting the nitty gritty immunologic details, in which case I'll be happy to pontificate). For now let's just say a lot of complex science and immunologic research is all pointing in the same direction: HIV is accelerating our aging process. (Suddenly I have the Beatles classic "When I'm Sixty-Four" running in a feedback loop through my brain: "Will you still need me, will you still feed me, when I'm sixty-four?")

Speaking of aging, as you may recall from my first HIV and aging blog entitled "Time Warp," I discussed "Angelennie," my loveably dear octogenarian parents. I need to provide you with an update. Just as they were settling into their "new normal" life at the snazzy and stunningly lovely assisted living facility at Saratoga Retirement Community, my mother suffered a massive stroke. She occluded her left middle cerebral artery, which resulted in paralysis of the entire right side of her body and face and inability to speak. This type of severe stroke has a 50% mortality rate, and the other 50% generally are left paralyzed and unable to speak. This horrendous event is a consequence of aging.

Despite the grim prognosis, however, miracles do happen. Due to the fact the stroke was witnessed by my dad, who immediately notified the facility's phenomenally attentive emergency response team, my mother was transported within minutes to a nearby stroke center. Very aggressive treatment with the clot-busting drug (TPA) given both intravenously and intra-arterially failed to dislodge the clot. However, fortunately the stroke center was equipped to perform a very risky procedure whereby the clot was dislodged mechanically with a MERCI retractor. (MERCI = Mechanical Embolism Removal in Cerebral Ischemia.)