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Author Topic: When to start meds docs dont even know  (Read 1159 times)

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Offline tommy246

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When to start meds docs dont even know
« on: September 09, 2009, 01:20:15 PM »
Its confusing for us recent poz to decide when to start meds as if the doctors differ on opinion what chance have we got on getting a clear picture.
some docs ignore the % some let the viral load float around a 100,000 as long as your cd4 count is ok and what is ok over 350 or over 500 its confusing.I think they started you late as possible before due to the side effects of the early meds but as the meds get better there is a trend to start people earlier.
I wish they could take a broad opinion poll of hiv docs views on this to help us make our decisions
jan 06 neg
dec 08 pos cd4 505 ,16%, 1,500vl
april 09 cd4 635 ,16%,60,000
july 09 ,cd4 545,17%,80,000
aug 09,hosptal 18days pneumonia cd190,225,000,15%
1 week later cd4 415 20%
nov 09 cd4 591 ,vl 59,000,14%,started atripla
dec 09  cd4 787, vl 266, 16%
march 2010  cd4 720 vl non detectable -20  20%
june 2010  cd4  680, 21%, ND

Offline Inchlingblue

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Re: When to start meds docs dont even know
« Reply #1 on: September 09, 2009, 01:42:34 PM »
I wish they could take a broad opinion poll of hiv docs views on this to help us make our decisions

I don't think the opinions of HIV doctors would be a good way to come up with a definitive answer, although it would be one more element to add to the equation and would be good to know.

Here is a list called "Rationale for Early Initiation of Therapy"

Availability of simpler, more effective, less toxic, and better tolerated regimens.

Data from cohort studies demonstrating benefit to earlier therapy with longer follow-up.

Theoretical risk of prolonged exposure to high VL, regardless of CD4 count (e.g. lymphoma, KS, neuro complications).

SMART study: increased morbidity and mortality (including from non-opportunistic complications) in pts who interrupted therapy compared to continuous therapy, regardless of CD4 count.

Early therapy may prevent emergence of X4- or dual/mixed-tropic virus, preserving benefit from CCR5 inhibitors.

May decrease HIV transmission (though increased risk of resistance transmission in pts failing therapy).

Evidence showing greater likelihood of CD4 normalization, with possible clinical benefits.


LINK:

http://www.hopkins-hivguide.org/management/antiretroviral_therapy/when_to_start_therapy.html?contentInstanceId=7666&siteId=

Offline sdguyloveslife

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Re: When to start meds docs dont even know
« Reply #2 on: September 09, 2009, 01:43:00 PM »
I'm a recent diagnosis myself too and I agree, there are opinions all over the board -- but medications seem to be such an individual decision as well.  I would suggest that you educate yourself as much as you can and decide for yourself what your own "medication threshhold" is going to be, and when you reach it, you go on meds.  The more I arm myself with knowledge before I show up for my appointments, the better I feel about the care I am receiving at the doctor's office.  

When I first tested positive and had no idea what my numbers were, one of the "very first" things they told me was that going on meds was MY decision and that I should not let any doctor tell me that I could not go on meds if I wanted them.  
Do not condemn the judgment of another because it differs from your own. You may both be wrong.

Offline tommy246

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Re: When to start meds docs dont even know
« Reply #3 on: September 10, 2009, 05:17:34 AM »
Well i dont know what to do as i think im not far away from starting,my record is diagnosed
DEC 08cd4 505  %16 vl 1600 ( infected sometime since 06 )
MARCH 09cd4 635 %16.5 vl 60,000
JUNE 09   cd4 535 %17 vl 80,000 
8thAUG 09  cd4 190 %9 vl 220,000 spent week in bed feeling rough(not very clever)before going to hospital on 8th,straight in stayed 18 days.
AUG 15  cd4 415 %21 vl not known.

They first suspected pcp and told me i would be starting meds either in hospital or upon leaving and it didnt bother me as you have no choice than to except it and as my cd4 was so low it was almost a relief. However a week later my cd4 and % had bounced back and it wasnt pcp so the hiv specialist decided it wasnt an oi and was not going to start me on meds yet .Next blood draw 8 oct ,will get results 30th oct. They said i had pnuemonia caused by unknown germ.
« Last Edit: September 10, 2009, 06:26:17 AM by tommy246 »
jan 06 neg
dec 08 pos cd4 505 ,16%, 1,500vl
april 09 cd4 635 ,16%,60,000
july 09 ,cd4 545,17%,80,000
aug 09,hosptal 18days pneumonia cd190,225,000,15%
1 week later cd4 415 20%
nov 09 cd4 591 ,vl 59,000,14%,started atripla
dec 09  cd4 787, vl 266, 16%
march 2010  cd4 720 vl non detectable -20  20%
june 2010  cd4  680, 21%, ND

 


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