Charlie Sheen goes off his meds

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    Jan 12, 2016 8:30 PM GMT
    Previously undetectable, he felt so good he was going to try a holistic approach. In one week his numbers were already up.....not good!



    http://www.people.com/people/article/0,,20979414,00.html

    In another article he says he is going back on meds. If nothing else it shows how well ART works.....and how necessary it is to keep at it. And that alternative medicine, especially from a quack, is very dangerous.
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    Jan 12, 2016 8:45 PM GMT
    So if you're undetectable that means you can't infect another person? But the virus is still in your body. Where is it?
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    Jan 12, 2016 11:22 PM GMT
    Lumpyoatmeal saidSo if you're undetectable that means you can't infect another person? But the virus is still in your body. Where is it?


    Essentially, yes. Partners Study had no infections within discordant couples, with sustained ART. (4 infections from outside source<<
    A new infection can be >1,000,000 After 6 months on ART it is usually <50. The old marker for undetectable was <200. The tests have gotten more sensitive.

    Ever seen a bottle of Goldschlager? Imagine a vat of that with one tiny fleck of HIV in the blood. HIV is still present, mostly in organs. It is contained. If there's any viral shedding from the organs to the blood stream the medications kill that.
  • Rhi_Bran

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    Jan 15, 2016 12:27 AM GMT
    Previously undetectable, he felt so good he was going to try a holistic approach.

    This is exactly what killed Steve Jobs, and why I don't take flak against modern medicine. People are so fucking stupid and can't be bothered to learn the least bit about their afflictions or how medications work to help them. Millions more would be dead today if it weren't for antiretroviral therapy, and this dolt thinks he knows better than everyone else and can come off his meds without consequences.

    So if you're undetectable that means you can't infect another person? But the virus is still in your body. Where is it?

    The jury is kind of out on that one. There is conflicting evidence - some say you can't infect another person while undetectable, while others say you can. The key is that "undetectable" as a medical term means the virus cannot be detected in your blood. It does not consider if there is an appreciable amount of virus in your semen. However, it stands to some reason that if there is no appreciable virus circulating in your blood, that there shouldn't be enough in your semen, either. I read somewhere that the chances of an undetectable person infecting someone else are about the same as a detectable person infecting someone who is currently on PrEP. Very low, but still possible.

    As for where the virus goes when you're "undetectable" - HIV is a retrovirus, meaning it inserts its own genetic code into your cells and as the cell performs its translation and replication process, the viral code hijacks the genetic translation and forces your cells to produce more virus instead, causing eventual cell death. Most strains of HIV have adapted so that in the presence of unsatisfactory environmental conditions for replication (ie, when there are ART medications in your blood), the viral genetic code that has integrated with your immune cells' DNA (known as a provirus) can lay dormant and wait until conditions are clear to replicate and proliferate again. In this hidden state, your immune system can't detect the virus nor can ART touch it, because the infected cell has not produced virus for your immune system or drugs to target. Soon after you stop medication, bam - the virus awakens and begins to replicate again. There are also certain areas of your body that HIV hides in that drugs in your blood can't touch, such as in your brain and bone marrow.

    That's why it's so difficult to cure. Any cure would either have to a) identify and kill proviral cells without releasing more virus, or b) prevent HIV from binding to new immune cells at all.
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    Jan 15, 2016 8:47 AM GMT
    Rhi_Bran said...

    Thanks guys for the answers.
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    Jan 15, 2016 2:49 PM GMT
    Rhi_Bran saidPreviously undetectable, he felt so good he was going to try a holistic approach.

    This is exactly what killed Steve Jobs, and why I don't take flak against modern medicine. People are so fucking stupid and can't be bothered to learn the least bit about their afflictions or how medications work to help them. Millions more would be dead today if it weren't for antiretroviral therapy, and this dolt thinks he knows better than everyone else and can come off his meds without consequences.

    So if you're undetectable that means you can't infect another person? But the virus is still in your body. Where is it?

    The jury is kind of out on that one. There is conflicting evidence - some say you can't infect another person while undetectable, while others say you can. The key is that "undetectable" as a medical term means the virus cannot be detected in your blood. It does not consider if there is an appreciable amount of virus in your semen. However, it stands to some reason that if there is no appreciable virus circulating in your blood, that there shouldn't be enough in your semen, either. I read somewhere that the chances of an undetectable person infecting someone else are about the same as a detectable person infecting someone who is currently on PrEP. Very low, but still possible.

    As for where the virus goes when you're "undetectable" - HIV is a retrovirus, meaning it inserts its own genetic code into your cells and as the cell performs its translation and replication process, the viral code hijacks the genetic translation and forces your cells to produce more virus instead, causing eventual cell death. Most strains of HIV have adapted so that in the presence of unsatisfactory environmental conditions for replication (ie, when there are ART medications in your blood), the viral genetic code that has integrated with your immune cells' DNA (known as a provirus) can lay dormant and wait until conditions are clear to replicate and proliferate again. In this hidden state, your immune system can't detect the virus nor can ART touch it, because the infected cell has not produced virus for your immune system or drugs to target. Soon after you stop medication, bam - the virus awakens and begins to replicate again. There are also certain areas of your body that HIV hides in that drugs in your blood can't touch, such as in your brain and bone marrow.

    That's why it's so difficult to cure. Any cure would either have to a) identify and kill proviral cells without releasing more virus, or b) prevent HIV from binding to new immune cells at all.


    No "The jury is kind of out on that one. There is conflicting evidence - some say you can't infect another person while undetectable, while others say you can."

    Of course anyone can argue anything. Someone may argue the world is still flat. It doesn't make it so.

    New research shows probability of transmission is zero while on antiretroviral treatment.

    A groundbreaking study on antiretroviral treatment showed that the drugs can disable HIV and stop sexual transmission. The randomized study of 1,700 couples was conducted by UNC-Chapel Hill and confirmed a 2011 study that stated ART could prevent transmission of HIV if it is taken reliably. The medications suppress HIV and can render it virtually harmless, unable to transmit to a sexual partner.


    http://hiv.aaci.org/2015/07/27/breakthrough-study-shows-zero-hiv-transmissions-when-undetectable/


    I don't how to be any clearer than that. It isn't just one study either. It's been repeated (a scientific requirement) several times over: Partners Study, Swiss Statement, Opposites Attract, etc.

    Your assertion that HIV drugs can't touch the brain is not true. Even though there is a blood/brain barrier they do of course 'touch'.

    The brain is a sanctuary or compartment site. Although HIV drugs do not permeate the brain: "Reducing HIV in blood and lymph nodes seems to stop HIV related complications in other compartments (eg in the brain) even if HIV drugs don’t penetrate these parts of the body."

    "In practice, because blood is used for most tests, you are unlikely to know exactly what is going on in other compartments. For most people (approximately 90%) an undetectable viral load in blood means undetectable viral load in other compartments."

    http://i-base.info/ttfa/section-2/11-compartments-and-sanctuary-sites/

    "Today’s potent drug treatments can eradicate HIV from the blood, but the virus must survive elsewhere in the body, because it returns when people stop taking these drugs.

    It has been assumed that the virus hides out in immune cells at various “sanctuary sites”, either replicating very slowly or becoming completely dormant. Supporting this, biopsies reveal the virus in sites such as patches of immune tissue in the gut."

    https://www.newscientist.com/article/dn27112-hivs-hiding-places-at-last-revealed-by-simple-scan/

    There are attempts at a "shock and awe" approach to get these vestiges of dormant HIV exposed for an actual cure. We'll see.
  • Rhi_Bran

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    Jan 16, 2016 1:52 PM GMT
    Of course anyone can argue anything. Someone may argue the world is still flat. It doesn't make it so.

    New research shows probability of transmission is zero while on antiretroviral treatment.


    I could quote you at least half a dozen different articles saying otherwise. We could quote articles at each other all day, but in the end it does not matter. What matters is that yes, there are large bodies of conflicting evidence. It does not matter how much you quote that supports your own views or opinions. Considering that even aids.gov advises that there is still a chance with an undetectable load, especially if you have another concurrent STD infection.
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    Jan 16, 2016 6:20 PM GMT
    Rhi_Bran saidOf course anyone can argue anything. Someone may argue the world is still flat. It doesn't make it so.

    New research shows probability of transmission is zero while on antiretroviral treatment.


    I could quote you at least half a dozen different articles saying otherwise. We could quote articles at each other all day, but in the end it does not matter. What matters is that yes, there are large bodies of conflicting evidence. It does not matter how much you quote that supports your own views or opinions. Considering that even aids.gov advises that there is still a chance with an undetectable load, especially if you have another concurrent STD infection.


    In the end it sure does matter!

    You can quote some old stats, but the preponderance of NEW evidence does not agree with you.

    The laws have changed in many countries and states. Laws lag behind science. But once codified THE SCIENCE is accepted as law.

    "The preventative effect on HIV transmission of being virally suppressed due to antiretroviral therapy (ART), as recognized by the Swiss Commission for HIV/AIDS in 2008, has helped to reduce the criminalization of HIV exposure in Switzerland. Since the Swiss statement's release, there have been acquittals of two HIV exposure cases in 2009, no further prosecutions for HIV exposure and alterations to the law used in these cases, according to study results presented at EACS 2013 in Brussels, Belgium."

    http://www.thebodypro.com/content/73508/reduced-hiv-criminalization-in-switzerland-after-s.html



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    Jan 16, 2016 7:12 PM GMT
    Rhi_Bran saidOf course anyone can argue anything. Someone may argue the world is still flat. It doesn't make it so.

    New research shows probability of transmission is zero while on antiretroviral treatment.


    I could quote you at least half a dozen different articles saying otherwise. We could quote articles at each other all day, but in the end it does not matter. What matters is that yes, there are large bodies of conflicting evidence. It does not matter how much you quote that supports your own views or opinions. Considering that even aids.gov advises that there is still a chance with an undetectable load, especially if you have another concurrent STD infection.



    That has been accepted time over time. ACON (who I respect enormously) agrees with the concurrent STD statements.

    But, is it true? People in every ART study have NOT gotten HIV, yet some HAVE gotten STDs.


    Sept 16, 2015

    "What about sexually transmitted infections (STIs)?

    If you are not on treatment, some STIs can make you more infectious: for instance, syphilis can double your viral load. HIV-negative partners are also more likely to get HIV if they have an STI. However, in the PARTNER study, there was not a single HIV transmission even though many people had STIs."
    http://www.aidsmap.com/Viral-load-and-transmission-a-factsheet-for-people-with-HIV/page/1044617/#item2989913


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    Jan 16, 2016 7:38 PM GMT
    Lumpyoatmeal saidSo if you're undetectable that means you can't infect another person? But the virus is still in your body. Where is it?

    You CAN still infect others, although the risk is lower. "Undetectable" simply means the sensitivity of the HIV tests cannot detect it, but it's still there. And it only takes one virus to infect someone.

    Also consider this: these are blood tests, not tests of male semen. Which stores in your body for a while before ejaculation. And if it contained HIV, which is how bottoms contract it during anal sex, the virus also lingers, and isn't being measured by any blood test.

    Plus, a blood test is today. And it takes a week or more to get the results. What's the status about 3 or 4 weeks later? Viral loads rise and fall. Was he undetectable during blood both drawn & tested TODAY? If a guy says he's undetectable, was that test run THIS MORNING? If not, neither you nor he really know what his HIV load is at the moment.

    Caveat emptor.
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    Jan 16, 2016 8:12 PM GMT
    Art_Deco said
    Lumpyoatmeal saidSo if you're undetectable that means you can't infect another person? But the virus is still in your body. Where is it?

    You CAN still infect others, although the risk is lower. "Undetectable" simply means the sensitivity of the HIV tests cannot detect it, but it's still there. And it only takes one virus to infect someone.

    Also consider this: these are blood tests, not tests of male semen. Which stores in your body for a while before ejaculation. And if it contained HIV, which is how bottoms contract it during anal sex, the virus also lingers, and isn't being measured by any blood test.

    Plus, a blood test is today. And it takes a week or more to get the results. What's the status about 3 or 4 weeks later? Viral loads rise and fall. Was he undetectable during blood drawn & tested TODAY? If a guy says he's undetectable, was that test run THIS MORNING? If not, neither you nor he really know what his HIV load is at the moment.

    Caveat emptor.


    You are confused as usual. It's the NEGATIVE person who doesn't know his status from one day to the next. It's interesting how you continue to propagate your own myths to vilify HIV+ men. IF maintaining viral suppression was as volatile as you surmise, why were there NO INFECTIONS in Partners/Opposites/HPTN-052?

    While it usually takes 6 months +- to reach undetectable levels, and 3-4 tests a year. The testing is to verify undetectable, but also to check for resistance, toxicity, liver functions etc.



    Isn’t the viral load in semen, vaginal fluids or rectum more important than viral load in blood?

    Viral load in blood and in other body fluids is usually very similar – if HIV in your blood is undetectable, it’s likely to be undetectable elsewhere. Occasionally people have undetectable HIV in blood and have low levels of HIV in other body fluids, but rarely at infectious levels.

    http://www.aidsmap.com/Viral-load-and-transmission-a-factsheet-for-people-with-HIV/page/1044617/#item2989913

    As for your assertion that being undetectable is just "lower" read this:

    When presenting the findings at a major conference, Jens Lundgren, MD, chief physician and director of the Copenhagen HIV Programme, estimated that the chance of transmitting HIV when the virus is fully suppressed by ARVs is close to zero, and might even be zero.

    http://www.aidsmeds.com/articles/HPTN_052_transmission_1667_27517.shtml

    Your comment ""Undetectable" simply means the sensitivity of the HIV tests cannot detect it, but it's still there. And it only takes one virus to infect someone." is so stupid, I don't know how to begin.

    There is nothing 'simple' about it! Getting HIV from ONE copy of the virus? Are you fucking kidding me? There isn't a set threshold to getting HIV.....but 1 isn't it. The lowest anyone has been infected is 362.

    That kind of empty headed logic simply defies logic. It is a pathetic attempt to discriminate against ALL HIV+ men, no matter what they do, even when they get their viral load down to ONE in your hypothesis! Your ignorance knows no bounds.
  • Rhi_Bran

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    Jan 19, 2016 1:01 AM GMT
    Theoretically, it IS possible for a single virus to establish an infection if it successfully infiltrates a circulating immune cell and produces enough viable particles. However, the vast majority of shed HIV particles are not viable, because HIV proviruses activate after processes of genetic correction within immune cells that would normally fix errors within the normal genetic code of the immune cell. While this may seem like a weakness, it's also one of HIV's greatest strengths - it ensures that nearly every new particle is a mutated version, different from the virus that infected the cell.

    When presenting the findings at a major conference, Jens Lundgren, MD, chief physician and director of the Copenhagen HIV Programme, estimated that the chance of transmitting HIV when the virus is fully suppressed by ARVs is close to zero, and might even be zero.

    The keyword there is "might". Personally I don't think there's enough evidence to support your claim, and I don't think there ever will be - how can you prove that a new infection as a result of relations with a + individual on medication is either the result of a small lapse in medication, or due to a few viable virus particles sneaking through even after medication? One should always treat every sexual encounter as having a non-zero chance of infection, regardless of whether or not every party's status is known. That's not discrimination. That's caution.

    The lowest anyone has been infected is 362.

    How the fuck can anyone reliably measure or ascertain this? A viral load measured at the time of discovering someone elses infection probably will not be the same as the viral load measured at some point in the past. It fluctuates slightly even when on meds. There isn't a fucking fitbit that tells you what your load is at any given time.
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    Jan 19, 2016 2:40 AM GMT
    Rhi_Bran saidTheoretically, it IS possible for a single virus to establish an infection if it successfully infiltrates a circulating immune cell and produces enough viable particles. However, the vast majority of shed HIV particles are not viable, because HIV proviruses activate after processes of genetic correction within immune cells that would normally fix errors within the normal genetic code of the immune cell. While this may seem like a weakness, it's also one of HIV's greatest strengths - it ensures that nearly every new particle is a mutated version, different from the virus that infected the cell.

    When presenting the findings at a major conference, Jens Lundgren, MD, chief physician and director of the Copenhagen HIV Programme, estimated that the chance of transmitting HIV when the virus is fully suppressed by ARVs is close to zero, and might even be zero.

    The keyword there is "might". Personally I don't think there's enough evidence to support your claim, and I don't think there ever will be - how can you prove that a new infection as a result of relations with a + individual on medication is either the result of a small lapse in medication, or due to a few viable virus particles sneaking through even after medication? One should always treat every sexual encounter as having a non-zero chance of infection, regardless of whether or not every party's status is known. That's not discrimination. That's caution.

    The lowest anyone has been infected is 362.

    How the fuck can anyone reliably measure or ascertain this? A viral load measured at the time of discovering someone elses infection probably will not be the same as the viral load measured at some point in the past. It fluctuates slightly even when on meds. There isn't a fucking fitbit that tells you what your load is at any given time.


    "Personally I don't think...." is an opinion. Getting HIV from it sneaking through? Viable particles? While, like Charlie, viral load will go up quickly when stopping meds. HIV doesn't sneak through. There undoubtedly a threshold, we don't know exactly what it is. Yet.

    I guess since you don't "fucking" know, no one else can either? http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.525.8972&rep=rep1&type=pdf

    You may not think it's safe enough. For you that's true. I'm not accusing you of discrimination. There are many couples gay and straight where this is a real issue.

    Dr Julio Montaner said "...we know that, after you become (viral-load) suppressed, in the absence of other co-morbidities – STIs and the like – the likelihood of transmission is very, very, very low indeed. Now, the problem here is that people very often want to know is there a risk or isn’t there a risk? And that’s a different discussion. We cannot prove the absence of risk.”

    Montaner adds: “So I’m perfectly comfortable to tell people that if you want to go forward and have, for example, unprotected sex while you are being protected by antiretroviral therapy, that is perfectly acceptable. On the other hand, you need to know that in the process of doing that, if there was a breakdown in adherence for example, you put yourself at risk. As long as you are willing and able to live with that kind of small risk, I’m perfectly happy to live with it.”

    “Some people, they want to be 100% sure that there is no risk. So they are not very comfortable with this kind of approach. What I usually tell people is look, if you think wearing condoms is the way to go and you are happy to advise and counsel people that condoms are as good as safe sex, I think you should be fully comfortable with advising fully suppressed individuals on HAART that they are as well protected as when using condoms, if not better protected. If they are concerned and want to use HAART and condoms, that would be even more protective. But that’s a judgement that fully informed couples should make.”

    “If you are asking me,” Montaner says, “I’m very comfortable that properly used HAART is at least as protective – or more –than condoms.”

    Notice he says a breakdown in adherence, not by 1 copy of the virus sneaking by.

  • Apr 19, 2016 8:02 PM GMT
    I do this all the time. Still strong as an ox!