WHO wants HIV patients treated sooner to save lives, halt spread

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    Jun 30, 2013 7:34 PM GMT
    LONDON -- Doctors could save 3 million more lives worldwide by 2025 if they offer AIDS drugs to people with HIV much sooner after they test positive for the virus, the World Health Organization [WHO] said on Sunday.

    http://www.nbcnews.com/health/who-wants-hiv-patients-treated-sooner-save-lives-halt-spread-6C10497442
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    Jul 01, 2013 12:00 AM GMT
    For some reason, the word "duh" comes to mind.
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    Jul 25, 2013 3:13 AM GMT
    There are 2 sides to this argument. First, things always come down to money and HIV drugs don't come cheap, we are talking in the hundreds every month. For some countries such as New Zealand (and I am sure many other countries) our funded health scheme 'Pharmac' is under pressure not only funding HIV patients but all the other conditions that people suffer from and need funding. There is only so much in the kitty and only so much tax people want to pay.
    Secondly, there is the medical side of the coin which says it is not necessary to go on HIV medication unless your CD4 count drops below 500 (it use to be 350 but now doctors are saying 500). There are only a selection of drugs available to HIV patients, some of which are not suitable for patients depending on their tolerance to those drugs, that leaves only few other possible combinations. If a drug causes terrible side effects, doctors will try the next choice, if that is not good they will try the next choice. One can never go back to the first choice again but the danger is if you run out of choices what is left?
    So the theory is, why start people earlier than they have to if their life span could be lessoned by starting too early.
    If a society is wanting to push governments to start HIV patients on meds the moment they are found to be HIV+ purely to protect the HIV- population from the possibility of contracting it then I think there is a problem. Getting an HIV+ persons viral load down to zero is not a 100% save guard for an HIV- person if they choose to have unprotected sex.
    It comes down to responsibility - everyone has to be responsible for their own health. If an HIV- person thinks he can go through life having rampant bareback sex but not catch HIV because 'hey, everyone is on meds now so its OK' will have another thing coming!.
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    Jul 25, 2013 3:25 AM GMT
    paulflexes saidFor some reason, the word "duh" comes to mind.

    tumblr_inline_mn1rptNv3T1r0fpej.gif
  • musicdude

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    Jul 25, 2013 3:37 AM GMT
    guysers saidThere are 2 sides to this argument. First, things always come down to money and HIV drugs don't come cheap, we are talking in the hundreds every month. For some countries such as New Zealand (and I am sure many other countries) our funded health scheme 'Pharmac' is under pressure not only funding HIV patients but all the other conditions that people suffer from and need funding. There is only so much in the kitty and only so much tax people want to pay.
    Secondly, there is the medical side of the coin which says it is not necessary to go on HIV medication unless your CD4 count drops below 500 (it use to be 350 but now doctors are saying 500). There are only a selection of drugs available to HIV patients, some of which are not suitable for patients depending on their tolerance to those drugs, that leaves only few other possible combinations. If a drug causes terrible side effects, doctors will try the next choice, if that is not good they will try the next choice. One can never go back to the first choice again but the danger is if you run out of choices what is left?
    So the theory is, why start people earlier than they have to if their life span could be lessoned by starting too early.
    If a society is wanting to push governments to start HIV patients on meds the moment they are found to be HIV+ purely to protect the HIV- population from the possibility of contracting it then I think there is a problem. Getting an HIV+ persons viral load down to zero is not a 100% save guard for an HIV- person if they choose to have unprotected sex.
    It comes down to responsibility - everyone has to be responsible for their own health. If an HIV- person thinks he can go through life having rampant bareback sex but not catch HIV because 'hey, everyone is on meds now so its OK' will have another thing coming!.


    this. not to mention that being on a daily cocktail isn't always easy. there are plenty of things that can happen in a lifetime that can cause a person to miss a dose, a day or even multiple days of therapy. this can in turn cause resistance to the medication. if a particular strain develops enough resistances then we'd have a super-drug resistant-strain that we couldn't manage
  • musicdude

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    Jul 25, 2013 3:41 AM GMT
    plus, this approach pushes the idea that all the blame is to be put on the person who is poz. a neg person is just as accountable as his infected counterpart. it's just as much his duty to ask the other person's status as it is the duty of a poz guy to declare his status. either way, if you're neg and you want to stay that way then use a condom no ifs, ands or buts
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    Jul 25, 2013 3:47 AM GMT
    guysers saidThere are 2 sides to this argument. First, things always come down to money and HIV drugs don't come cheap, we are talking in the hundreds every month...

    Secondly, there is the medical side of the coin which says it is not necessary to go on HIV medication unless your CD4 count drops below 500 (it use to be 350 but now doctors are saying 500).

    It is also expensive to fight cancer, and other diseases. But the total cost can actually be less, and the outcome better, with early detection that leads to earlier treatment.

    The "medical side of the coin" you quote is part of the article. The very latest evidence indicates that aggressive and early treatment does benefit HIV patients. Like many things in the medical field this debate has swung back and forth over the years: don't treat until symptoms develop, don't treat until certain viral load and T-cell thresholds are met, versus do treat from earliest detection.

    The salient points I hoped readers would take from the article include the need for regular HIV testing, so people know as early as possible when they have contracted HIV. And to consult with their doctors, to see what treatment regimen they should undergo, and how soon. If it turns out that you should begin at the earliest, you won't be doing that if you go undiagnosed for a couple of years due to not having yourself tested. And become part of that tragic 3 million number the doctors could have been able to save.

    I took my friend paulflexes "duh" comment as meaning everyone should already know this. Unfortunately the reality is otherwise, as I know through working with the HIV community. Lack of education is our greatest obstacle.

    And speaking of lack of education, the terminally moronic blasiankid tried a cheap shot at me, based on this misunderstanding. I care nothing about his personal slam at me, but do care that he might cause guys here to miss the important message in the article I linked above. That the guidelines guysers quotes are obsolete today, and there is new guidance to consider in fighting against HIV.
  • musicdude

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    Jul 25, 2013 3:54 AM GMT
    treating cancer and treating HIV are two different things. although i get where you're coming from, i have to say that the reference is flawed. catching cancer early means less evasive or radical treatments and normally results in cheaper cost. also, once the cancer is gone a patient doesn't have to keep paying for the treatments.

    when it comes to treating HIV, although the side effects lessen if treatments start earlier, the fact remains that the cost of medication (which you'd now have to stay on for the rest of your life) does not. the patient also needs to be very strict when it comes to taking his medication and not forgetting or ending up in a situation where he runs out and does not have access to more.
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    Jul 25, 2013 3:58 AM GMT
    ART_DECO said


    And speaking of lack of education, the terminally moronic blasiankid tried a cheap shot at me, based on this misunderstanding. I car nothing about his personal slam at me, but do care that he might cause guys here to miss the important message in the article I linked above. That the guidelines guysers quotes are obsolete today, and there is new guidance to consider.


    What are you talking about? My post had absolutely nothing to do with you AT ALL! I'm laughing at Paul saying "duh" not anything you had to say. You need to become educated yourself and quit making asinine assumptions about other people you do not know. I'm not trying to make anyone miss anything important about this topic nor am I trying to take a "cheap shot" at you. Trust that you are nowhere near as important as you may think you are and I don't know you well enough to even attempt to badmouth you. Seems like you're a bit egocentric and altruistic in your statement but that's just me. However, I submit to you that if you're going to poke holes and call me "uneducated" you can at least put a spell check on your comment before posting it, making yourself look like an idiot.
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    Jul 25, 2013 4:01 AM GMT
    musicdude saidtreating cancer and treating HIV are two different things. although i get where you're coming from, i have to say that the reference is flawed. catching cancer early means less evasive or radical treatments and normally results in cheaper cost. also, once the cancer is gone a patient doesn't have to keep paying for the treatments.

    when it comes to treating HIV, although the side effects lessen if treatments start earlier, the fact remains that the cost of medication (which you'd now have to stay on for the rest of your life) does not. the patient also needs to be very strict when it comes to taking his medication and not forgetting or ending up in a situation where he runs out and does not have access to more.

    Treating HIV can cost much less when it doesn't progress to full-blown AIDS. And AIDS is the risk when HIV treatment is delayed. I went through that with my late partner, and with friends. Studies are now showing that early & aggressive HIV treatment can bring the viral load down to undetectable levels, greatly reducing the onset of AIDS.
  • musicdude

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    Jul 25, 2013 4:14 AM GMT
    so lets see, one three month refill costs me about 4080$ (and that was when i was on the cheap meds). that's four refills a year (16320$) for the rest of my life. that's 408000$ by the time i'm 50.

    if treatment is delayed, and if your CD4s don't come back up after primo infection, and if your viral load stays super high after primo infection, then yes you end up having to deal with aids related issues and your chances of effectively taking to the medications and surviving greatly diminish. (i should know, that's what i went through and the reason why i started on meds within a year of being infected)

    IF, however, your CD4s stabilize after primo infection and your viral load diminishes, then you could live a healthy and normal life for years before having to pay/take meds and having to regiment yourself religiously and constantly worry about the whole thing.

    if you can be healthy without the meds, then why put yourself through the financial and psychological strain? as long as you're closely monitored by a physician, and start treatment when things change, you'll be fine
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    Jul 31, 2013 9:56 AM GMT
    I cannot speak for medical practices in America, but here in New Zealand HIV+ people are at the mercy of Pharmac and the so called 'best practices' of doctors. Our doctors in New Zealand do not share the theory that early medication is the best way to go, wether this is just the $$$ talking I don't know. But one could ask to go on meds early, chances are they won't get it (well, funded that is).
    Ive been told its on a case by case basis, some people go on meds within 1 years of diagnosis, others can be 8 years before starting. It depends on the individual and whats happening to them.
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    Jul 31, 2013 10:06 AM GMT
    paulflexes saidFor some reason, the word "duh" comes to mind.


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    Aug 05, 2013 10:10 PM GMT
    ART_DECO said
    guysers saidThat the guidelines guysers quotes are obsolete today, and there is new guidance to consider in fighting against HIV.


    If your evidence is concrete, better contact our New Zealand health system/providers of this evidence, because I am only telling you how New Zealand operates. Our HIV specialists are always going overseas to Australia, England, Asia and America to learn new 'best practices'. As it stands in NZ the 'best practices' are as I mentioned (unless a patient has specific symptoms that require meds sooner than others).