I have a friend of a friend who have been living with HIV for about 12 years. He is not sick but his doctor suggested that he goes on medication because recent studies show that early treatment = longer life. Is this true? His T-cell count is about 430 and his viral load is around 5000. Also, he is worry about the medication. How is it is going affect his life?
I have read some of the posts in the forums but I can not find any good advice. I really hope someone can answer this question. Thank you in advance!
There are a plethora of medication options available now. The are all expensive and they all have side effects. Not everyone gets all the possible side effects.
I am not a doctor, Nor I am I him. If I was him ( 430 T cells, 5k VL ) I would keep waiting. No, first I would draw a graph of the T Cells and Viral Load over the last 12 years. Then I would probably continue "watchful waiting"
For many years it was recommended to begin therapy for HIV once the CD4+ falls to 200 cells.
AIDS is defined as a CD4+ count of 200 or less or having an opportunistic infection (even though the CD4+ could be higher than 200)
The recommendations now is to treat anyone who has a CD4+ count less than 350 cells. If there is an opportunistic infection, therapy is initiated no matter what the CD4+ count is.
There are recent studies that have shown treating asymptomatic individuals with CD4+ above 350 cells will improve survival.
It sounds like his physician is aware of these recent studies.
Of course starting Highly Active AntiRetroviral Treatment ( HAART) is expensive. There are many medications to choice from if side effects from one medication is intolerable.
I'm a PA-C in internal medicine/HIV. we have over 1800 patients. new data (from retrospective studies.... i.e. looking back in time) show that patients who began HAART when CD4 counts were above 500 did do better over time. however, federal guidelines still suggest that a CD4 count ≤350 and a viral load ≥100,000 are the limits at which HAART should be considered UNLESS clinical presentation and/or opportunistic infections warrant earlier treatment. the federal government may change the CD4 count to ≤500 in the next few years, but as of now have not done so.
your friend must weigh the tradeoffs... long-term impact from side effects of the medications versus the possible benefit from starting treatment with CD4 count above 500. only after lots of research should he make that decision for himself in consultation with his care provider.
I take a different approach to this whole HIV problem.
I sell to Biotechnology companies in The SF Bay area and have since 1980 almost the beginning of Biotech. All The early companies got started and funded by doing AIDS and later HIV work. Almost all my friends got AIDS and are now are dead most dying in early to mid 80's. All went to the best doctors money could buy and these doctors ended up specializing in AIDS and then HIV. They took early and most of edge cutting medication. Again all dead. I was a conduit of the newest and great med therapies because all my clients worked on them. I knew the newest drugs before the CDC did and kept my friends informed.
So the only ones I know that were infected early that are still alive never took any of the medication. Two were in the HEP B group from 1978 that were found to be HIV infected then, Still alive doing very well and still not taking treatment. They all saw their lovers and friends die a horrible death. Not wanting to die that way they chose not to take medication. You do the math on the years since 1978 they have been alive. I know a few that started early treatment for a few years than stopped again still alive. A close friend infected 7 years ago was taken off meds after being on them for 5 yrs. his health has improved greatly.
If he was my friend and after 15 yrs of working with Bio (HIV) companies , drugs, CDC surveillance reports and reading Tens of thousands of research papers on HIV both pro and con I would tell him.
Not to relinquish his intellect or knowledge to any health care provider or to anyone. He should be the only one responsible for his health and what he should and should not take. Go back to the beginning and read and study the papers, reports pro and con of HIV, AIDS and the medications. Know your drugs inside and out. Read research papers on HIV by many of the scientists that invented things like PCR and many of the newer drugs.
It make take years and I mean years but it is his life not anyone else.
I greatly appreciate and thank you for the quick responses. I will definitely email this post to my friend. Please keep the comments coming. I have read some articles regarding this topic but I am still perplexed by the research and the findings. I am not sure what advice to offer my friend. I guess the best I can do is be there for him if and when he needs me. "Life is too short... Just enjoy the best moments of each day with no regrets!"
