Meds, Mind, Body & Benefits > Questions About Treatment & Side Effects

Experts debate when to start HIV therapy

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J.R.E.:
For those that want to delay treatment,  ( I was one), you may want to read this :

http://www.medicalnewstoday.com/releases/285972.php?tw

Delaying ART in patients with HIV reduces likelihood of restoring CD4 counts

Mightysure:
My baselines were CD4 1034 and VL 636. My doctor insisted I start treatment and after careful consideration I agreed. I'm almost a week into Stribild and with all the side effects I'm questioning my decision.

buginme2:
This debate is over.

Who is still debating this?

alberche:
I started meds very early, two and a half months after infection, that was more than 8 years ago. Since then I have always been over the 1.000 CD4s and undetectable. My average CD4 account has been between 1300 and 1600 during all these years.

Why did I started so soon?

I was diagnosed very early. My doc at that time proposed me to start. I was well  informed about med options, pros and cons. I thought that if I was given a lifespan of more than 30 years after starting meds at the 500 or 350 mark, which will be -in the long term- the difference between starting early or waiting, let's say, 5 or 6 years until I got some 500-400 CD4?. Is there actually any difference as per regards of long term medication side effects comparing 25 years to 30 years on meds? Most probably not much. In addition, starting early could help to preserve more of my immune system, both qualitative and quantitative, improving my general health status in the future.

Also I wondered about whether I could cope with the anxiety of being not on meds, knowing my immune system, maybe also my brain and other organs will be progressively deteriorating during some 5 to 7 years.

So I decided to go and start meds back then.

After almost 9 years, I am satisfied with my decision.

The pros, I am in good health, high CD4 and undetectable VL, also in a constant range of figures, no big oscillations. I was also diagnosed with syphilis and could control it rapidly, in less than six months, with the antibiotics, thanks to my high CD4 levels (otherwise it may take years to curb it down). And last, but not least, taking pills since the beginning made me conscious of my condition since the very beginning, which helped me to assume I had to take more care of myself. Also, the fact of being in a reasonable good health condition has made possible for me to keep my job and other activities as usual.

The cons: the burden of treatment, the more frequent medical appointments, the issues for traveling with meds (both holidays and work travels). Some meds' side effects, such as rash and gastrointestinal in the first year, bone density loss since some years ago, lipids and cholesterol always on the edge of high levels, even if eating healthy-low-fat food... nothing too though one could not cope with. Delaying meds start maybe could spare me these issues for some years, that's all.

Nevertheless, in spite of starting meds, I couldn't skip to pass through the same mood, psychological or maybe depression issues I see other people living with HIV is passing through as well. And this is the point on which I feel most vulnerable right now and HIV medication makes no difference about it.

So, starting soon I think is a good decision as per regards of keeping your health as good as possible and to improve your long term quality of life. But it certainly makes no difference about the psychological issues of having HIV. My advise will be, get as much information as you can, be conscious about the effort of taking your pills regularly, adherence is very important for meds to work well and reducing viral resistance issues, and start the sooner as from the moment you feel prepared to take meds.

Hugs :-)

AJinSAC:
Thank you Dr. Strange Love for the post.  Great thread of comments.  Yes the definitive answerer is still out. My thoughts and story include the longevity of being non (or slow) progressor, along with the public health model of "treatment now" was my decision to start Stribuild last year.   The slogan HIV Stops with Me, hit home.  Since starting treatment and the positive effects of being undetectable had a substantial mental health boost, a relief of being less likely to infect someone else.  For twenty years the burden of feeling infectious chipped away at me.  Safe sex usually practiced but years of acting out in easily accessible SOMA Bars and Clubs the reality was it wasn't always going to happen.  This chipped away at my psychy and no judgment. 

I'm 50 years old and from the generation of wait and see, so starting treatment was not something I wanted to do, or needed to do, as for some reason my body maintained tcells 400-1200 for ~20 years with the virus.  It was scary starting treatment, Strbuild a good six weeks of side effects and the occasional headache now a days.  The relief has been worth it for me, maybe even accepting the fact, dealing and moving forward too. 

The current public health model, HIV meds as a prophylactic and through early treatment and PREP, is hopefully a way to help stop the spread of HIV.  It is still an individuals choice, when to start treatment.  These shared stories may help.

More funding and research is needed to work on even better treatments, cost effective, and global availability.  Public health leaders and advocates need to continue to work on the stigma, mental health and substance abuse issues that are too frequently intertwined.  A pill does not fix all.

Thanks for letting me share.  Have a great new year!  ::)

Hugs,

A.J.

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