How dumb can experts get?

[newt]

What if everyone with HIV were put on meds, not necessarily to protect their own health but to reduce the risk of spreading the virus to others?

This is on a par with the director of the Harvard AIDS Institute proposing Sustiva as first-line therapy for Rwanda with no back-up combo and no mental health interventions.

I am glad to see the proposal is roundly criticized...

- matt

[Dachshund]

I guess they figure everyone would be on the toilet all day and would have no time for doing the dirty.

[alisenjafi]

Matt at the risk of being called a flame baiter (how gay) it's like deja vu all over again.
I can' t help but think of those volcanologists who were so dogmatic they went and got killed in a volcano that blew because they didn't want to believe a fellow scientist's theory.
God bless 'em all- if I believed in her.
Cheers
Johnny

[Tim Horn]

It's insane.  

While everyone agrees that reducing viral load is more than likely associated with a reduced risk of HIV transmission, so does simply knowing whether or not you're infected.  There have been several studies indicating that people who know they're infected are more likely than not to take necessary steps and precautions to reduce the risk of transmitting the virus to somebody else.  Hence, I'm a firm supporter of things like routine testing, rapid testing, and all that.  

But treatment for this purpose?  I mean, come on.  Let's try stepping up testing and counseling initiatives -- around the world -- and seeing what impact this has on the course of the HIV pandemic first.  I mean, talk about warped priorities.  

Tim Horn  

[HIVworker]

Maybe there would be a larger push for better drugs - given all the side effects?

I think it's a great idea. Anyone want to buy the Brooklyn Bridge?

R

[Ann]

What kind of kick-backs do you suppose this professor was promised from the makers of Sustiva brand dire-rear? What a jerk.

[zephyr]

Hear Hear, Ann....

I so wonder how much $, too.

Jerk is right.

Zeph

[wellington]

Isn't this the proposal from a BC (Canada) doctor who will become the president elect at the end of the current international conference? The media here in Canada have been flogging HIV/AIDS related stories for the last few weeks, as the conference draws neigh, and my eyes are getting so sore from all the rolling. At least our malady is on the minds of more people, which can't necessarily be a bad thing.

[Matty the Damned]

It's partly this sort of constant pressure that I think makes me unwilling to take medication.

MtD

[jkinatl2]

It's partly this sort of constant pressure that I think makes me unwilling to take medication.

MtD

That plays a significant role in my decision as well.

[Eldon]

Hello Newt, it is Eldon. After reading the link you provided, I am in total agreement with Tim that it is INSANE! Can we please focus on a vaccine?

[CalvinC]

The proposal will be part of Toronto's hiv/aids conference next week, ie, there will be a paper delivered. It will be interesting to see how the media react.

On the other hand, good news: the Gates Foundation just laid down a half a billion for hiv/aids research. THAT is great news!

Andrew

[Cliff]

It's not so much that the idea seems silly that bothers me, it's that the idea is coming from someone who was recently voted President of the International Aids organization (or something like that).  What does this say about his Presidency? 

The assumption behind this idea is that people who are positive continue to spread the disease to others (intentionally I suppose).  So put them on meds and that will stop them.  I don't think that assumption is correct.  People who don't know their status spread the disease.  And knowing that even the President of the organization can make that kind of assumption about people (knowingly) living with HIV is a bit unnerving.

[newt]

"The availability of rapid HIV testing coupled with a new highly effective one-pill-a-day, fixed-dose, drug combination represents a unique opportunity to expand global HAART programs and potentially curb the global growth of the pandemic." says the press release. Okay, so it's a marketing front for Atripla.

Clearly, this will only work if you make testing compulsory and treatment too, and can guarantee it's use, which is an entirely accceptable approach to coralling people into the hosptials, isn't it?

[Cliff]

Actually I noticed that.  When I read it, I thought the drug has only been around for a couple of weeks and he's already trying to push it on everyone.  Not to mention it's not for everyone and yet he seems to suggest that just because one one-pill a day regimen is available, we should start with global treatment. 

I'd like to see how he plans to pay for this initiative.  I can't think of any government that isn't cash-strapped, the last thing they need is to pay for unnecessary, expensive medical treatment.

[Boo Radley]

When there are non-toxic therapies that insure long, trouble-free (virally and chemotherapeutically speaking) lives I can see advocating drugs for everyone infected.  We're not even close.

Why not give chemotherapy to all smokers to prevent them from getting lung cancer?   Makes almost as much sense.

Boo

[sfpvguy41]

I guess I'm missing something.  Why is this bad?  To me anything that advocates expanded use of HAART is a good thing esp in the developing world.  One writer I saw blog on this idea is Andrew Sullivan, who is HIV+...althought it doesn't necessarily mean Atripla.

The fact that HAART makes HIV less transmissable is one reason I started on the early side as I have a negative boyfriend....

Robert

[Boo Radley]

I guess I'm missing something.  Why is this bad?  To me anything that advocates expanded use of HAART is a good thing esp in the developing world.  One writer I saw blog on this idea is Andrew Sullivan, who is HIV+...althought it doesn't necessarily mean Atripla....
Robert

Expanded use of HAART and mandatory HAART are not the same.  I'm all for expanding use of the drugs that are keeping me alive and believe the USA and other wealthier nations should contribute large amounts to the global HIV battle.  But forcing people to take drugs we cannot guarantee will prolong their lives is unethical and I'd say, if I had morals, immoral.  Also, the reasoning seems similar to the "hit early, hit hard" HAART philosophy that seems to me to have been abandoned after no benefits could be found to validate the theory. 

I went on the drugs when I believed it was in my best interest to do so, not when my doctor recommended I start.  No matter how you look at it HAART is chemotherapy -- more like cancer drugs, not aspirin for headaches!.  When I first elected not to do HAART the guidelines for initiating therapy were for CD4 counts under 500.  A few years ago the guidelines changed the CD4 count to 350.  It took over 10 years for my CD4s to fall below 350 (and very luckily my viral load was never greater than 17,000).  I didn't infect anyone during that time and I look at it as 10 years added to my life BC (before chemo). 

I believe forcing people to start HAART would doom thousands or millions to shorter lives due to long-term toxic side effects and more rapidly developed drug-resistance/progression to terminal AIDS (I may be shaky in the second opinion but firmly believe no one has solved the problem of long-term side effects -- of course, we are the current guinea pigs in the long-term side effects study).  Advocating HAART as prophylaxis against spreading infection cannot be compared to other "necessary" (forgive me for being a quotation queen -- it's a terribie habit) public health measures such as curtailing the spread of TB or diptheria or typhoid or smallpox -- a tiny fraction of people inocculated for smallpox, typhoid, measles, etc. are harmed by these measures.  Many more people with HIV develop resistance to HAART meds and there aren't enough meds to insure one will have them for 30, 40, 50 or more years. 

That's why I say when we have meds for life everyone who is infected can safely take the drugs -- and it would be nice if newer drugs had less severe short and long term side effects!  But I still wouldn't force someone to go on HAART if the likelihood was great that adherence would be poor, unless we want to lock them up in quarantine and force them to take the drugs.  O Brave New World!

But I digress.

Boo

P.S.  Since I droned on so long I won't engage in one of my standard tirades against Andy Sullivan.

[jkinatl2]

Boo Radley, I could not agree with you more. I would enjoy reading a tirade regarding Mr. Sullivan, but challenge you to try writing it without using the terms "right wing shill" or "self-important media whore." Myself, I have not been able to succeed as of yet.

As for the problems with mandatory drugs, you are spot-on. WE are the guinea pigs, and enough of us are crippled with PN and disfigured with lipo to give any rational person pause before embarking on the journey.  Add to that the significant psychotropic impact of Sustiva with the dearth of mental health counseling in developing nations, and it's a recipe for disaster.

[jack]

Its amazing to me that so many drs. and experts don't believe how bad sides are for some people. They think we are making it up or exaggerating.  I am to the point I dont know if its the drugs or I am just getting old,either way I am way fucked

[jkinatl2]

Jack, it's not only many doctors. Many people with HIV scoff at the concept of debilitating side effects. Especially people who are treatment naive/newly diagnosed/recently started on treatment. I mean seriously, you read LIVING WITH. Some of us don't bother posting about medical treatment issues much, because invariably we get deluged with people stating "well THAT didn't happen to ME" with the imtimation that we are either lying or "doing something wrong" or simply flawed in some way.

[Boo Radley]

Boo Radley, I could not agree with you more. I would enjoy reading a tirade regarding Mr. Sullivan, but challenge you to try writing it without using the terms "right wing shill" or "self-important media whore." Myself, I have not been able to succeed as of yet.

jk,

You're far too genteel.  I call Andrew Sullivan the Embassador of Bareback and a suppuratiing canker on society's ass.  I never recovered from the unconscionable "HIV isn't such a big deal (really, it's sorta hot)" piece he did a couple of years (or less) ago.  It's one thing to be a pseudo-liberal mouthpiece for the right wing but quite another to tacitly endorse the religious right's wish to eradicate homosexuals via any method possible.  He doesn't write very well, either.  And if he advocates mandatory HAART let him be among the alpha testers of new drugs and therapies.   I recently chastised a poster on a listserv I subscribe to because he restrains his friend from attacking Mr. Sullivan whenever he sees him out and about in NYC. 

Sorry, didn't mean to hijack this thread.                                                          (Jesus, Eds, please remove this feature ASAP!  Nobody needs to be this expressive...)
I strongly, emphatically believe mandatory HIV chemotherapy is wrong, wrong, wrong -- on too many levels to enumerate.  Well, I enumerated a few previously but there are many others noted by other posters or which can be noted by more people as the thread weaves its way.  I hope! 

I believe those living with HIV should agitate strongly against this theory and enlist our medical care professionals to sign on to our shared experiences of treating HIV and being treated for HIV infection.  It's scary to think an idea like this might gain currency but I've been frightened ever since January 21, 2001

boo!  -- George W. Bush's grandma-ma (or Norman Bates's mother -- you decide)

Boo