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To look at Nelson Vergel, you would never guess what he has been through. For 35 years, he has kept up a relentless fight against HIV, but his muscular physique is that of a man decades younger. Regular workouts, fatty breakfasts of arepas stuffed with cheese and eggs — a staple of his native Venezuela — and 32 massive pills a day have kept him fit and driven the virus from his blood. And yet, all is not well.

Four years ago, Vergel developed and beat lymphoma. He has irritable bowel syndrome, chronic diarrhea, and severe fatigue, and in 2015, he had surgery on his right hand for a nerve disorder; he still can use only one finger on that hand to type. “Chemo was nothing compared to that,” he says.

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Vergel, 59, attributes most of these conditions to his low CD4 count, a key marker of immune function in HIV-positive people. He is what’s known as an immunologic non-responder (INR) — someone whose immune system does not rebound even after years of antiretroviral therapy. There are tens of thousands of these non-responders in the U.S., whose low CD4 numbers put them at much higher risk of heart attacks, stroke, cancers, secondary infections such as tuberculosis, and death. And yet, drug companies and researchers aren’t actively pursuing new treatments that would boost their immunity, leaving people like Vergel feeling neglected.

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