As they mark their 10th anniversary of being infected with a virus that most consider a death sentence, a group of people in California is living proof that attitude can make a difference.
No one in the group of 65 people who tested positive 10 years ago for HIV, the virus that causes AIDS, has developed the disease, and all continue to be active, take daily medication and function like anyone else, according to their doctor.
It's not known why some people with HIV develop AIDS immediately, while others, like the San Francisco group, remain disease-free.
"We're amazed when we see their lab results," said Dr. Marcus Conant, an AIDS expert at the University of California School of Medicine. "We shake our heads and say, 'this individual should be very sick. Five years ago he would have been dead.'"
Dr. Conant said no one in the 65-person group has developed any symptoms associated with AIDS. "Nor have they developed illnesses that would make them stop working or otherwise reduce their quality of life. They feel good, look good, and enjoy their work."
Yet, he stressed, their immune systems have deteriorated alarmingly over the years.
Dr. Conant recommends a wellness program that includes stress reduction, rest and exercise.
He said agressive drug therapy, exercise and a positive attitude, can triple the life span of people infected with the virus.
"Aggressive, positive patients live much longer and better than those who say, 'Why me? It's so unfair,' and withdraw," Dr. Conant said. "I really push exercise. Studies show that exercise helps sustain HIV-infected people physically and emotionally. My patients ski, jog, surf and work out as much as possible."
Dr. Ronald Grossman, a New York internist who treats a large number of AIDS patients, cautioned against too much exercise.
"I recommend the basic aerobic and muscle-building exercises three times a week, 40-60 minutes each session, no more," Dr. Grossman said. "Overexertion can cause weight loss."
Earvin "Magic" Johnson, the former Los Angeles Laker basketball player who tested positive for HIV in November, retired from the sport after the Lakers team doctor said continuing to play might weaken his immune system.
Mr. Johnson won the Most Valuable Player award Sunday in the National Basketball Association All-Star game with nine assists and 25 points, nine of which came off three, 3-point shots in the last three minutes of the game.
Mr. Johnson said he wanted to prove to people that a person who is infected with HIV can still do his job.
Many doctors treat people infected with HIV with the two approved anti-AIDS drugs, AZT or DDI. Therapy usually begins when a person's number of infection-fighting cells, called CD4 cells, drops below a certain number.
Dr. Conant prescribes AZT and a drug used to prevent Pneumocystis carinii pneumonia, a common AIDS-related lung infection when a patients' CD4 cells fall to a certain number.
Dr. Grossman agreed that early aggressive drug therapy and a sensible lifestyle can lengthen lifespan.
But not every doctor agreed with Dr. Conant's combination drug regimens.
Dr. Brady Allen, an AIDS specialist at Baylor College of Medicine in Dallas, said there is no reason to prescribe a drug to prevent the AIDS-related pneumonia to all patients.