A little over a month ago I was diagnosed with AIDS. This came after two different medical therapies for the past eight and a half months. At present I am on a drug holiday and pursuing alternative therapies. I am seeing a physical therapist who is teaching me about meditation and exercise, and I will see a chiropractor tomorrow to begin acupuncture. I really want to stay off the toxic medications that don't seem to do me any good anyway. The schedule and side effects of the drugs have proven worse than the disease. I would appreciate your input.

F.W.

Without treatment, most people who become infected with HIV (the virus that causes AIDS) will develop the various infections or tumors that define the advanced stage of the infection we call AIDS and die in an average of seven to 12 years. People also receive an AIDS diagnosis if the level of T cells (the main immune cell that is destroyed by HIV) falls below a certain level. Now, however, with the use of combinations of anti-HIV drugs known as drug cocktails or highly active antiretroviral therapy (HAART), many patients do well with little progression of their disease. It is not clear how long these patients will continue do well, but in some, the infection has not progressed at all for more than six years (when HAART first became available). Most of these patients have no detectable levels of virus in the blood.

I am not sure why you have had a bad experience with the drug cocktails. It is true that all of these antiretroviral drugs have some toxicity. But there are quite a few choices now, and doctors usually can help their patients find a tolerable regimen. It is also true that at least three different drugs are given each day, which must be taken on schedule. However, some are taken once a day, and no commonly used drugs are given more than twice daily, so the drug regimens are not nearly as difficult to take as they previously were.

I am wondering if you did not respond to the medications. About 70 percent of patients who had no previous antiretroviral therapy will have such a good response that the level of the virus in the blood will be undetectable. In the others, there is still usually some response to treatment. It seems that you have had several different treatment regimens, and some of them may have been suboptimal by today's standards. The older regimens had some benefit, but nothing like the current regimens with some of the newer drugs. When doctors first started treating AIDS patients with AZT (zidovudine, or Retrovir) and the few other drugs that were available, only one or two of the drugs were given at a time because there were no other options. If you took one of these early medications, either alone or combined with one other drug, it would make it less likely for you to respond to the current three-drug cocktails. It is only relatively recently that we have known that three drugs are needed for an optimal response.

As far as the treatments you are now pursuing, I can only say this: There are no alternative treatments that have been proven to prolong survival in patients with AIDS. Exercise probably has some benefit, and no one can exclude the benefits of positive thought and meditation. But studies have clearly demonstrated that HAART prolongs survival from this deadly illness. I would recommend to any of my patients who had AIDS that they begin HAART.