The Center for Special Immunology (CSI) is committed to early intervention against HIV-related disease and has been operating in California since 1990. When CSI initially directed its attention to early intervention against HIV and the development of AIDS, many people both within and outside the medical profession doubted the merit of such an effort. Public funding for clinical research in this area was non-existent. Treatment criteria were uncertain and some of the expensive testing procedures were of questionable utility. The availability of anti-viral drugs was limited and their efficacy and toxicity subject to much speculation. The consensus in the public health sector was to focus on laboratory research on the one hand and treatment of late-stage disease on the other. Early intervention was considered highly speculative and not generally indicated.

CSI's response to the general skepticism was to privately create a clinical research and treatment unit dedicated to early intervention with two primary attributes; a commitment to basic medical principals including meticulous diagnosis, aggressive preventative medicine, carefully monitored therapy and team-oriented holistic case management; and a flexible and forward-looking use of state-of-the-art medical technology and promising new drugs. Ahead of the consensus of the time, CSI offered its patients an aggressive therapeutic option instead of the pervasive fatalism then present. The hundreds of patients now under CSI's care come from that segment of the population which understood the HIV disease is progressive and that denial of the condition in its earlier, potentially more treatable, stages would only result in the development of the stage final illness.

The early intervention approach as conceived and practiced by CSI, can be applied to three areas of concern. The first area is intervention against active HIV infection itself, as early possible in its course, while the immune system remains relatively intact and before advanced immunodeficiency or AIDS develops. The second area involves measures to prevent the development of opportunistic infection in patients who have evidence of advanced immunodeficiency but who have not yet become clinically ill. If these patients can be kept well for longer periods, viral therapy and immunmodulators may be given the time needed to have a better chance for success. The third area focuses on the aggressive diagnosis and treatment of conditions that are the consequences of advanced immunodeficiency in patients who are clinically ill. These conditions, including infections and cancers, can usually be more successfully treated with great benefit to the patient if they are diagnosed earlier in their course. The results, both of controlled studies and accumulated empirical data, support the initial optimism regarding the potential of early intervention to halt the progression of HIV infection and to favorably alter the outcome of other HIV-related disease.

CSI was established as a privately funded organization with the aim of combining the most productive and efficient elements of the current medical models; the teaching hospital, corporate group practice and independent private practice. CSI has remained a self-funded organization, thereby avoiding the constraints of government or foundation funding. Patients are charged only for those services that are reimbursed by their insurance coverage while CSI covers other research-related expenses.

CSI's effective performance to date is largely based upon a professional staff with a shared sense of initiative and commitment, an eagerness for inquiry and the consideration of new options and enthusiastic participation in a collaborative process of discussion and problem solving. Through this approach, CSI continues to put into clinical practice new protocol elements that anticipate the future consensus...

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