Well Controlled HIV - Risks of Death No Higher Than Rest of Population...

[OneTampa]

Recent study article link:

http://medicalxpress.com/news/2013-03-death-patients-well-controlled-hiv-aids.html

[Dr.Strangelove]

Thanks for the link.

The new study provides the best evidence yet that, with effective ART that achieving good disease control, the mortality rate for people with HIV is essentially the same as in the general population.

That's good to know. I'll keep this article ready for those people who insist that despite ART I 'will get sick and die of AIDS eventually' *sigh*

[Miss Philicia]

I was honestly hoping to avoid living to be 85 and wearing adult diapers.

ps: this study is flawed because it doesn't discuss the high suicide rate of pozzies.

[buginme2]

This study is also flawed because it only takes into account people who have a sustained cd4 count of 500-1000. 

Many people with HIV fail to achieve a cd4 count above 500.  The study noted that those with cd4 counts less than 500 had a significantly higher risk of death.

"Patients with below-normal CD4+ cell counts (350 to 499 cells/mm3) were at elevated risk of death. Based on the standardized mortality ratio, the risk of death in this group was 77 percent higher than in the general population."

Considering much of the world won't even start treatment until you reach a cd4 count of 350 or less, many people don't achieve a response above 500.  Not to mention the scores of people who are diagnosed later.

Not to mention, are they discounting all the people who died of cancer?  Many cancers are related to HIV. 

Just seems that the news is great when you can cherry pick your study population.

http://www.sciencedaily.com/releases/2013/03/130311150951.htm

[jkinatl2]

This study is also flawed because it only takes into account people who have a sustained cd4 count of 500-1000. 

Many people with HIV fail to achieve a cd4 count above 500.  The study noted that those with cd4 counts less than 500 had a significantly higher risk of death.

"Patients with below-normal CD4+ cell counts (350 to 499 cells/mm3) were at elevated risk of death. Based on the standardized mortality ratio, the risk of death in this group was 77 percent higher than in the general population."

Considering much of the world won't even start treatment until you reach a cd4 count of 350 or less, many people don't achieve a response above 500.  Not to mention the scores of people who are diagnosed later.

Not to mention, are they discounting all the people who died of cancer?  Many cancers are related to HIV. 

Just seems that the news is great when you can cherry pick your test subjects.

http://www.sciencedaily.com/releases/2013/03/130311150951.htm

I submit that the news might be great for newly diagnosed people, or people who were diagnosed and responded favorably to treatment before their CD4 counts fell below 500. Sadly, many of the people in this forum alone (many of them newly diagnosed) do not meet that criteria.

There is compelling evidence that longevity and quality of health are more accurately measured by the nadir cd3 count. In other words, at our current (albeit fluid) quality of care, if you had a cd4 count of 100, but now have a cd4 count of 800, your lowest measured cd4 count is the standard used to determine your personal health prognosis. Well, that and the zillion other things that each individual possesses which makes up their biology.

That's one of the reasons it is frustrating when a study is taken out of a rather narrow context (and which is useful in a data extrapolation manner by researchers) and then foisted on the masses as though we were groundbreaking.

I have zero doubt that I, having a current cd4 count of 250 and a nadir of 12, will live much longer thanks to ART. I do not, however harbor optimism that I will see my 70th birthday. Given my medical health, ongoing and past issues, scarring of the lungs, damage to the brain and what-not, I think I will be a marvel if I limp past 60.

And I really am perfectly OK with that. Sure I have wasted gobs of time. Weeks, sometimes months. But when I have had the strength/willpower/courage to live fully, I think I've enjoyed an eventful, if not particularly noteworthy series of circles around the sun. Been nicer than I have been mean (sorry cabal, it's true.) Loved hard and long and usually pretty well. Paid Goddamned attention whenever I, well, thought to pay Goddamn attention, and failed as exquisitely as I have triumphed.

I can also make a red beans and rice that you would literally enjoy if you had to eat it out of the warm, scooped-out chest cavity of a human toddler.

These studies are great for research. Their translation into the real world remains to be seen.  Of course, add to the caveats the US's whopping 25% drug rate of treatment success/adherence, throw in some crystal meth, and other societal junk, and it really boils down to what a person is willing to do in order to promote that holy grail of a normal lifespan.

I honestly think most of our newly diagnosed members will meet or exceed that. Not because I have faith in their ability to adapt to their diagnosis. No, this forum is rife with biostasis. However, for the lucky ones (and most newly diagnosed and some of us Jurassic folks) medical science is struggling to, and I predict will, close the gap between effective treatment and easy treatment.

These studies, as John Cougar-Mellencamp so eloquently put it, "Stand on this single print of time."

[Common_ground]

This study is also flawed because it only takes into account people who have a sustained cd4 count of 500-1000. 

Many people with HIV fail to achieve a cd4 count above 500.  The study noted that those with cd4 counts less than 500 had a significantly higher risk of death.

"Patients with below-normal CD4+ cell counts (350 to 499 cells/mm3) were at elevated risk of death. Based on the standardized mortality ratio, the risk of death in this group was 77 percent higher than in the general population."

Considering much of the world won't even start treatment until you reach a cd4 count of 350 or less, many people don't achieve a response above 500.  Not to mention the scores of people who are diagnosed later.

Not to mention, are they discounting all the people who died of cancer?  Many cancers are related to HIV. 

Just seems that the news is great when you can cherry pick your study population.

http://www.sciencedaily.com/releases/2013/03/130311150951.htm

The study do include people with cd4 of 350 - 500 as well. Is 77% alot? In relation to what? Smoking? Obesity? Alcohol? Drugs? Well it depends.

If you would have read the study more carefully it says "The most common causes of death were cardiovascular disease or sudden death, responsible for 31 percent of deaths; and non-HIV-related cancers, 19 percent."
So no, cancers included.

[jkinatl2]

The study do include people with cd4 of 350 - 500 as well. Is 77% alot? In relation to what? Smoking? Obesity? Alcohol? Drugs? Well it depends.

If you would have read the study more carefully it says "The most common causes of death were cardiovascular disease or sudden death, responsible for 31 percent of deaths; and non-HIV-related cancers, 19 percent."
So no, cancers included.

Mayhaps, but didn't a recent study correlate an HIV diagnosis with a 50% rise in cardiovascular-related deaths.

http://www.aidsmap.com/HIV-and-antiretroviral-therapy-increase-risk-of-cardiovascular-disease-shows-meta-analysis/page/2493594/

Even - especially - with certain ART. Honestly I am not being a Debbie Downer here. Just trying to find perspective in what often amounts to a shrill keen of unbridled optimistic lust which is inevitably tempered with the multitude of caveats from those whose anecdotes differ.

[Common_ground]

There is compelling evidence that longevity and quality of health are more accurately measured by the nadir cd3 count. In other words, at our current (albeit fluid) quality of care, if you had a cd4 count of 100, but now have a cd4 count of 800, your lowest measured cd4 count is the standard used to determine your personal health prognosis. Well, that and the zillion other things that each individual possesses which makes up their biology.

The study contradicts that.

"...in HIV-infected patients with a CD4+ cell count of 500 cells/mm3 or higher, the risk of death was not significantly higher than in the general population. For this group, the risk of death was essentially normal regardless of how low the CD4+ cell count dipped during treatment, as long as it returned to normal."

[Miss Philicia]

Frankly I don't really care about any of this because we're all going to be cured by bee stings next month.

[Common_ground]

Mayhaps, but didn't a recent study correlate an HIV diagnosis with a 50% rise in cardiovascular-related deaths.

http://www.aidsmap.com/HIV-and-antiretroviral-therapy-increase-risk-of-cardiovascular-disease-shows-meta-analysis/page/2493594/

Even - especially - with certain ART. Honestly I am not being a Debbie Downer here. Just trying to find perspective in what often amounts to a shrill keen of unbridled optimistic lust which is inevitably tempered with the multitude of caveats from those whose anecdotes differ.

I often stress that we need to see people live a normal lifespan to actually be able to claim that "normal life expectancy" can be achieved with HIV. So sure, we are not really over the bridge yet and its healthy , no pun inteded, to question, although I remain slightly optimistic and science seems to support that view in 2013.

[mecch]

Just because a study can be misunderstood by the public or pop culture or people who need to misapply everything to their self, as they are the center of the universe and everything is about them.... doesn't mean the news of the study wrong, or useless. 
This adds to the complex and contradictory experiences of millions of people living with HIV. Its not simple, black and white, same rules apply to everyone. As the french say, voila.   Some people will experience the life reported in the study, some people will not. (Some women lunch at the Plaza, ski in St. Moritz, and buy expensive furs ever year....Some women have the Ritz Thrift Shop... Some don't have the Ritz Thrift Shop... )
http://www.youtube.com/watch?v=Gg8Oj4Q_wB4
http://ritzfurs.com/location.html
 

[mecch]

   Anyway I agree with commonground we'll have to wait and see.  But we all know people have all sorts of different experiences living with hiv so..... the more info about those differences... the better??

[madbrain]

Thanks for the link.
That's good to know. I'll keep this article ready for those people who insist that despite ART I 'will get sick and die of AIDS eventually' *sigh*

Yes, like, say, life insurance companies.

[bmancanfly]

So much focus on quantity of life,  so little focus on quality.

I'd gladly trade years of life to feel again like I did before HIV.

[elf]

So much focus on quantity of life,  so little focus on quality.

True that.

[Dr.Strangelove]

Just because a study can be misunderstood by the public or pop culture or people who need to misapply everything to their self, as they are the center of the universe and everything is about them.... doesn't mean the news of the study wrong, or useless.

Exactly!

I often feel that people have problems interpreting scientific studies or putting them in perspective. In an ideal world science journalists should interpret the science and translate it to the general public. But more often than not they are doing a bad job and/or sensationalize.

What bothers me is that this kind of misinterpretation and poor understanding of scientific findings by the public falls back on the researchers and harms their reputation: When the bee-based HIV cure doesn't show up any time soon, it's the scientists who gave us wrong hopes and deceived us, right? Or if you caught HIV that one time in your life when you didn't use a condom then clearly the statistics about transmission risks must be all wrong...

It's just easy to blame something that you don't really understand. On the other hand I also think that many scientists do a poor job communicating with the public.

[mecch]

P.S. your avatar is so trippy....

[Mishma]

I submit that the news might be great for newly diagnosed people, or people who were diagnosed and responded favorably to treatment before their CD4 counts fell below 500. Sadly, many of the people in this forum alone (many of them newly diagnosed) do not meet that criteria.

There is compelling evidence that longevity and quality of health are more accurately measured by the nadir cd3 count. In other words, at our current (albeit fluid) quality of care, if you had a cd4 count of 100, but now have a cd4 count of 800, your lowest measured cd4 count is the standard used to determine your personal health prognosis. Well, that and the zillion other things that each individual possesses which makes up their biology.

That's one of the reasons it is frustrating when a study is taken out of a rather narrow context (and which is useful in a data extrapolation manner by researchers) and then foisted on the masses as though we were groundbreaking.

I have zero doubt that I, having a current cd4 count of 250 and a nadir of 12, will live much longer thanks to ART. I do not, however harbor optimism that I will see my 70th birthday. Given my medical health, ongoing and past issues, scarring of the lungs, damage to the brain and what-not, I think I will be a marvel if I limp past 60.

And I really am perfectly OK with that. Sure I have wasted gobs of time. Weeks, sometimes months. But when I have had the strength/willpower/courage to live fully, I think I've enjoyed an eventful, if not particularly noteworthy series of circles around the sun. Been nicer than I have been mean (sorry cabal, it's true.) Loved hard and long and usually pretty well. Paid Goddamned attention whenever I, well, thought to pay Goddamn attention, and failed as exquisitely as I have triumphed.

I can also make a red beans and rice that you would literally enjoy if you had to eat it out of the warm, scooped-out chest cavity of a human toddler.

These studies are great for research. Their translation into the real world remains to be seen.  Of course, add to the caveats the US's whopping 25% drug rate of treatment success/adherence, throw in some crystal meth, and other societal junk, and it really boils down to what a person is willing to do in order to promote that holy grail of a normal lifespan.

I honestly think most of our newly diagnosed members will meet or exceed that. Not because I have faith in their ability to adapt to their diagnosis. No, this forum is rife with biostasis. However, for the lucky ones (and most newly diagnosed and some of us Jurassic folks) medical science is struggling to, and I predict will, close the gap between effective treatment and easy treatment.

These studies, as John Cougar-Mellencamp so eloquently put it, "Stand on this single print of time."

I know I couldn't say it better than you have. Good points and insight. Like you I wonder if I'll make 60 (one year away) with all my quality of life issues I don't even know that I want to, had I not just met my new granddaughter!

[YellowFever]

Here's the link to the original paper:

http://journals.lww.com/aidsonline/documents/mortality_in_well_controlled_HIV_QAD_27_6.pdf

Also to note: Just because this study examines only a narrow subset of HIV+ people, doesn't mean that the study is flawed. It would be flawed if they concluded by generalising their results to the entire population, which they did not.

So then what good is the study then? Before this, other studies have shown that even those with VL/UD under ART do not get to live normal livespans. Which then begged the question: Are the meds shaving a few years of our lives? Is there some other metric of HIV that we could/should be measuring, instead of just viremia and CD4?

What this paper is essentially saying is that there is a lot of noise in the data for life-expectancy of HIV+ people and they are attempting to clean some of it up.