Standing in the hall, still clutching his his grocery bags, Bill felt calm and comforted. His burden was lifted.

Two weeks later, I saw Bill as a patient at my HIV clinic. He described his vision embarrassedly at first, but grew more and more enthusiastic in the telling. “It was a wonderful feeling,” he said. In a final rush he confessed he had stopped taking his HIV medications.

“I know, I know, it sounds crazy. It is crazy,” he said. “But I think I have to follow this through.” He alluded to the biblical parable of Abraham and Isaac, to faith that transcends reason. “This is my test,” he said.

I made sure he understood the risks of his decision. I did a careful neurological examination. I assessed Bill for signs of psychosis or delusional thinking. His partner Kay was with us and confirmed that Bill had been behaving normally otherwise, at home and in the floral shop they share. Kay was horrified by Bill’s decision. Also HIV-positive, Kay had taken HIV medicines for nearly a decade, too. “How could he throw it all away?” Kay asked.

HIV medications are widely regarded as a miracle of modern medicine. They have turned the HIV epidemic on its head; while HIV was once the leading cause of death among young Americans, life expectancy among people with HIV is now nearly normal.