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Author Topic: More reason to start treatment early...  (Read 2790 times)

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nychope1

  • Guest
More reason to start treatment early...
« on: November 12, 2010, 10:23:20 PM »
For those who are on the fence about when to start treatment; More reason to start treatment early...

http://commonhealth.wbur.org/2010/11/aids-prevention-and-cure/

 -Dr. Anthony Fauci, a leading expert on HIV/AIDS and director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health:

Do you think it’s possible to discover a cure for anyone and everyone infected with HIV?
"I think it’s attainable in some individuals, and I think you’d have to get them very early in the course of their infection. Once their immune system is so terribly damaged that when you stop therapy there’s not enough immunity left to contain the residual virus, then I don’t think it’s going to be possible.
So to be realistic, I don’t think it’s possible to even imagine a cure in everybody who’s HIV infected. But in some select individuals who get treated early in the course of infection, I do believe that this is feasible."

Many of you here know what he is talking about. (http://www.poz.com/articles/Anthony_Fauci_HIV_2536_19165.shtml) The reserves and sleeping cells and all. From what I have read he is speaking of a functional cure. I truly believe that with all of the other research going on eradication of the virus is just as possible so that those who have started meds later still have as good of a chance for a cure. 

It also seems to be the new school of thought among the disease control and medical community that starting treatment early can slow down the transmission of the disease because of undetectable viral loads. Not that one could not get it from someone who is UD but it may lower the risk slightly. Like an HIV+ woman who decides to have a baby. The viral load is brought down to UD and not passed on to the child. Not worth the risk for sure! Does makes some sense to me.
« Last Edit: November 12, 2010, 11:09:07 PM by nychope1 »

Offline wtfimpoz

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Re: More reason to start treatment early...
« Reply #1 on: November 13, 2010, 11:10:49 AM »
" think it’s attainable in some individuals, and I think you’d have to get them very early in the course of their infection. Once their immune system is so terribly damaged that when you stop therapy there’s not enough immunity left to contain the residual virus, then I don’t think it’s going to be possible."

Do we have a timeframe for how early in the course of infection he means, and how we can tell whether or not someone is a viable candidate?  He previously mentioned first three, maybe first six months after infection.  I don't think thats a realistic option for most people. 
09/01/2009-neg
mid april, 2010, "flu like illness".
06/01/2010-weakly reactive ELISA, indeterminant WB
06/06/2010-reactive ELISA, confirmed positive.

DATE       CD4     %     VL
07/15/10  423     33    88k
08/28/10  489     19    189k
09/06/10-Started ATRIPLA
09/15/10  420     38    1400
11/21/10  517     25    51

Offline Nestor

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Re: More reason to start treatment early...
« Reply #2 on: November 13, 2010, 11:27:14 AM »
" think it’s attainable in some individuals, and I think you’d have to get them very early in the course of their infection. Once their immune system is so terribly damaged that when you stop therapy there’s not enough immunity left to contain the residual virus, then I don’t think it’s going to be possible."

Do we have a timeframe for how early in the course of infection he means, and how we can tell whether or not someone is a viable candidate?  He previously mentioned first three, maybe first six months after infection.  I don't think thats a realistic option for most people. 

Indeed, considering how many people don't learn about their infection until some time after it happens.  I was diagnosed a year and a half after being infected, so even if I had started treatment immediately, I doubt that would fall into his category of "very early". 

If there were a cure, however, and it depended on starting treatment "very early", I suppose very frequent testing would be one way to solve that problem. 
Summer 2004--became HIV+
Dec. 2005--found out

Date          CD4    %       VL
Jan. '06    725    25      9,097
Nov. '06    671    34     52,202
Apr. '07    553    30      24,270
Sept. '07  685    27       4,849
Jan. '08    825    29       4,749
Mar. '08    751    30     16,026
Aug. '08    653    30       3,108
Oct. '08     819    28     10,046
Jan '09      547    31     13,000
May '09     645   25        6,478
Aug. '09    688   30      19,571
Nov. '09     641    27       9,598
Feb. '10     638    27       4,480
May '10      687      9    799,000 (CMV)
July '10      600     21      31,000
Nov '10      682     24     15,000
June '11     563    23     210,000 (blasto)
July  '11      530    22      39,000
Aug '11      677     22      21,000
Sept. '12    747     15      14,000

nychope1

  • Guest
Re: More reason to start treatment early...
« Reply #3 on: November 13, 2010, 11:36:14 AM »
Yes I agree with you. How is one supposed to know within three to six months. In my opinion getting tested twice a year if one is engaged in risky behavior and certainly getting tested if you think you even might have had the chance to be infected.
In anycase, from what I am reading, even if you're off by months or a few years it is still good to start treatment. it makes sense to me personally to stop any kind of virus or disease from progressing further. Some of the current regimes are pretty easy to adhere to and the side effects, at least in the short term, seem to be minimal and some not any. But again, that's my opinion.

Also, I decided to start at a cd4 of 525 and vl of 5200 which is not generally the recommended time by the pros but by an individualized basis. Although my ID doc who is the Director of ID and AIDS at a NYC hospital said if it were him he would.

I wholeheartedly recommend watching this web tutorial. http://app2.capitalreach.com/esp1204/servlet/tc?cn=poz&c=10189&s=20424&e=12198&&audio=false&br=80  

Offline wtfimpoz

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Re: More reason to start treatment early...
« Reply #4 on: November 13, 2010, 01:54:22 PM »
Frequently, people don't even produce antibodies for weeks or even months after being infected.  Add onto that  the added delay in seeing a doctor, waiting for test results, etc, and I'd think you'd have to test people MONTHLY or initiate treatment during seroconversion to even have a chance of beginning within the first three months.  Fauci's vision of a cure is utterly worthless to most of us who are already infected.  We should just call it out as it is.   
09/01/2009-neg
mid april, 2010, "flu like illness".
06/01/2010-weakly reactive ELISA, indeterminant WB
06/06/2010-reactive ELISA, confirmed positive.

DATE       CD4     %     VL
07/15/10  423     33    88k
08/28/10  489     19    189k
09/06/10-Started ATRIPLA
09/15/10  420     38    1400
11/21/10  517     25    51

Offline Rev. Moon

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  • Smart ass faggot ©
Re: More reason to start treatment early...
« Reply #5 on: November 13, 2010, 02:01:52 PM »
Well, we can wait a couple of years and see what happens to a couple of members such as myself, who actually started HAART while undergoing their acute infection (about three weeks into it for me; I believe Mechita started around the same time).

Is what this doctor says practical?  Perhaps not, since most people find out about their status several months after they became infected (or they avoid facing the truth and wind up having to deal with it when PCP or someting just as ugly rears its head).

Let it be noted however that I am not a "curester," whatever comes will. 

PS./ I don't believe that this topic belongs in the I Just Tested Poz forum; Living With or Research News (since the OP included links to articles from Dr. Faci) might be more appropriate.
"I have tried hard--but life is difficult, and I am a very useless person. I can hardly be said to have an independent existence. I was just a screw or a cog in the great machine I called life, and when I dropped out of it I found I was of no use anywhere else."

Offline wtfimpoz

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  • Let's make biscuits!
Re: More reason to start treatment early...
« Reply #6 on: November 13, 2010, 02:14:38 PM »
Well, we can wait a couple of years and see what happens to a couple of members such as myself, who actually started HAART while undergoing their acute infection (about three weeks into it for me; I believe Mechita started around the same time).

Is what this doctor says practical?  Perhaps not, since most people find out about their status several months after they became infected (or they avoid facing the truth and wind up having to deal with it when PCP or someting just as ugly rears its head).

Let it be noted however that I am not a "curester," whatever comes will. 

PS./ I don't believe that this topic belongs in the I Just Tested Poz forum; Living With or Research News (since the OP included links to articles from Dr. Faci) might be more appropriate.

It may also be worthwhile to note that Fauci is ONE DOCTOR, whose pessimistic opinion may not necessarily be gospel.  I'm fairly certain he's been wrong before.  While its unfortunate that the man holds the purse strings to a lot of AIDS research, there is a LOT of research being done, much of which contradicts what he says or thinks outside his box.  Our job should be to actively seek out and support THAT research.   
09/01/2009-neg
mid april, 2010, "flu like illness".
06/01/2010-weakly reactive ELISA, indeterminant WB
06/06/2010-reactive ELISA, confirmed positive.

DATE       CD4     %     VL
07/15/10  423     33    88k
08/28/10  489     19    189k
09/06/10-Started ATRIPLA
09/15/10  420     38    1400
11/21/10  517     25    51

Offline David Evans

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  • Member
  • Posts: 97
Re: More reason to start treatment early...
« Reply #7 on: November 13, 2010, 02:41:55 PM »
Hi all,

The folks are right that this really probably does belong in Research News, as it is a theoretical observation that hasn't yet been proved. Don't get me wrong. It's a really interesting and important discussion, but as it fits better under Research I am moving it.

David
Moderator

nychope1

  • Guest
Re: More reason to start treatment early...
« Reply #8 on: November 13, 2010, 02:59:33 PM »
The school of thought is that the less viral reserves in one's body the more chance it will eventually be able to treat if there is a functional cure down the road. This tells me personally the sooner one can stop or slow down the virus from entering into every corner of one's body the better. There may be a correlation between the time it takes for the virus to do this and a functional cure. Unless someone is a controller, (someone who has a genetic advantage over the virus), the HIV virus eventually does damage the body over time. Dr. Fauci is just one doctor and he is speaking to the functional cure not an eradication of the virus. There is a whole other paradigm out there looking for an eradication as well. I believe the doctor is encouraging early detection as an ideal.

Yes Dave and Rev. Moon, perhaps this thread now should move into another section. Initially I wanted to let newbies know there are options and just pass along some encouraging news. I am only three weeks diagnosed myself and deciding whether to start treatment was difficult to say the least.

To me Artipla and some of the other regimes are a miracle and I am thankful for them but it always is nice to think that we may be within strking distance of at least a functional cure. Like Measles and Small Pox and a host of othe viruses that there is no known cure, yet we don't even talk about them because they are completely controlled. I believe that is more than a reasonable expectation for HIV!

Best to all
« Last Edit: November 13, 2010, 03:17:51 PM by nychope1 »

Offline leatherman

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Re: More reason to start treatment early...
« Reply #9 on: November 13, 2010, 03:10:17 PM »
does anyone know of a report/study that shows how many people don't find out their poz status until sick and/or in the hospital? I only know from anecdotal evidence of people I've met that around 1/3 found out from testing and 2/3 found out when they became ill and/or were hospitalized. If the majority of people aren't finding out from early testing, this could be another bit of info that could prompt people to test and test frequently.
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Oh my friends, my friends forgive me
That I live and you are gone.
There's a grief that can't be spoken.
There's a pain goes on and on.
Empty chairs at empty tables
Where my friends will meet no more.

"Empty Chairs at Empty Tables" from Les Miserables

Offline Assurbanipal

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  • Taking a forums break, still see PM's
Re: More reason to start treatment early...
« Reply #10 on: November 13, 2010, 04:43:08 PM »
does anyone know of a report/study that shows how many people don't find out their poz status until sick and/or in the hospital? I only know from anecdotal evidence of people I've met that around 1/3 found out from testing and 2/3 found out when they became ill and/or were hospitalized. If the majority of people aren't finding out from early testing, this could be another bit of info that could prompt people to test and test frequently.

The surveillance system gathers these stats -- it's something like a third that are "diagnosed late" (including me)
5/06 VL 1M+, CD4 22, 5% , pneumonia, thrush -- O2 support 2 months, 6/06 +Kaletra/Truvada
9/06 VL 3959 CD4 297 13.5% 12/06 VL <400 CD4 350 15.2% +Pravachol
2007 VL<400, 70, 50 CD4 408-729 16.0% -19.7%
2008 VL UD CD4 468 - 538 16.7% - 24.6% Osteoporosis 11/08 doubled Pravachol, +Calcium/D
02/09 VL 100 CD4 616 23.7% 03/09 VL 130 5/09 VL 100 CD4 540 28.4% +Actonel (osteoporosis) 7/09 VL 130
8/09  new regimen Isentress/Epzicom 9/09 VL UD CD4 621 32.7% 11/09 VL UD CD4 607 26.4% swap Isentress for Prezista/Norvir 12/09 (liver and muscle issues) VL 50
2010 VL UD CD4 573-680 26.1% - 30.9% 12/10 VL 20
2011 VL UD-20 CD4 568-673 24.7%-30.6%
2012 VL UD swap Prezista/Norvir for Reyataz drop statin CD4 768-828 26.7%-30.7%

Offline mecch

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  • red pill? or blue pill?
Re: More reason to start treatment early...
« Reply #11 on: November 13, 2010, 05:45:39 PM »
Diagnosed in seroconversion before HIV+.  But didnt start HAART for a couple of months.  Horrible CD4 destruction!  But decent rebuild so far  ::)
Im waiting for the scrubbing bubbles that will clean out reservoirs for anyone, with little health impact. HAART seems to have little impact.  Why would someone destroy their health for a cure?  We'll see.
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline leatherman

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Re: More reason to start treatment early...
« Reply #12 on: November 13, 2010, 07:01:56 PM »
The surveillance system gathers these stats
no link? ???
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Oh my friends, my friends forgive me
That I live and you are gone.
There's a grief that can't be spoken.
There's a pain goes on and on.
Empty chairs at empty tables
Where my friends will meet no more.

"Empty Chairs at Empty Tables" from Les Miserables

Online tednlou2

  • Member
  • Posts: 4,602
Re: More reason to start treatment early...
« Reply #13 on: November 13, 2010, 10:03:43 PM »
does anyone know of a report/study that shows how many people don't find out their poz status until sick and/or in the hospital? I only know from anecdotal evidence of people I've met that around 1/3 found out from testing and 2/3 found out when they became ill and/or were hospitalized. If the majority of people aren't finding out from early testing, this could be another bit of info that could prompt people to test and test frequently.

I've always found the stats of how many infected vs how many know hard to believe.  Correct me if I'm wrong as I'm going off the top of my head here--- Aren't the stats that just over 1 Million Americans are infected and about a quarter don't know they are infected??  I'm just surprised by these figures.  I would think the people who don't know would be much higher than that.  I have no data to back that up--just my gut.  I would just think it is higher than that as many just don't get tested or are in denial about their chances of being poz.  I mean we hear that a huge percentage don't know they are poz until they end up in the ER with some awful OI.   

Offline Assurbanipal

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Re: More reason to start treatment early...
« Reply #14 on: November 13, 2010, 10:31:54 PM »
no link? ???

I thought google was your friend... :)

surveillance = cdc data
search string "cdc late diagnosed hiv"



first link http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5824a2.htm?s_cid=mm5824a2_e

 :-*
5/06 VL 1M+, CD4 22, 5% , pneumonia, thrush -- O2 support 2 months, 6/06 +Kaletra/Truvada
9/06 VL 3959 CD4 297 13.5% 12/06 VL <400 CD4 350 15.2% +Pravachol
2007 VL<400, 70, 50 CD4 408-729 16.0% -19.7%
2008 VL UD CD4 468 - 538 16.7% - 24.6% Osteoporosis 11/08 doubled Pravachol, +Calcium/D
02/09 VL 100 CD4 616 23.7% 03/09 VL 130 5/09 VL 100 CD4 540 28.4% +Actonel (osteoporosis) 7/09 VL 130
8/09  new regimen Isentress/Epzicom 9/09 VL UD CD4 621 32.7% 11/09 VL UD CD4 607 26.4% swap Isentress for Prezista/Norvir 12/09 (liver and muscle issues) VL 50
2010 VL UD CD4 573-680 26.1% - 30.9% 12/10 VL 20
2011 VL UD-20 CD4 568-673 24.7%-30.6%
2012 VL UD swap Prezista/Norvir for Reyataz drop statin CD4 768-828 26.7%-30.7%

Offline leatherman

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  • Google and HIV meds are Your Friends
Re: More reason to start treatment early...
« Reply #15 on: November 13, 2010, 11:11:57 PM »
I thought google was your friend... :)

search string "cdc late diagnosed hiv"
thanks. I do love google but it helps to know what to query. ;D asking "when do people find out that they have aids" doesn't turn up squat. LOL thanks for helping out and actually posting the link (and the info) that backs up your earlier comments.

there's going to be new data released sometime this year (or so they say LOL)
http://www.cdc.gov/hiv/topics/surveillance/resources/factsheets/us_overview.htm
Quote
CDC expects to release the next incidence estimates later in 2010.

Last Modified: July 26, 2010
Last Reviewed: July 26, 2010

and according to the CDC "Diagnoses of HIV infection and AIDS in the United States, 2008. HIV Surveillance Report, v. 20. Atlanta, GA: U.S. Department of Health and Human Services; 2010. (cited 2010 Sep 21)", http://www.cdc.gov/hiv/surveillance/resources/reports/2008report/, looking at tables 10-a and 10-b, it stills ranks at around 31-32% going from HIV to AIDS within the first 12 months after diagnosis. 

It's really troubling to see that all these years later 1/3 of pozzies in America still aren't diagnosed until they are that sick (sick enough to get an AIDS diagnosis). Think of all the years they're infected and out spreading HIV without knowing.
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Oh my friends, my friends forgive me
That I live and you are gone.
There's a grief that can't be spoken.
There's a pain goes on and on.
Empty chairs at empty tables
Where my friends will meet no more.

"Empty Chairs at Empty Tables" from Les Miserables

Offline ElZorro

  • Member
  • Posts: 535
Re: More reason to start treatment early...
« Reply #16 on: December 02, 2010, 08:00:01 PM »
Interesting article on this topic. Those of us who are newly infected should read past the first couple of paragraphs before freaking out, though:


HIV in the UK still cuts 13 years off life expectancy: late testing is the main reason


http://aidsmap.com/news/HIV-in-the-UK-still-cuts-13-years-off-life-expectancy-late-testing-is-the-main-reason/page/1558930/

(in case you decided to freak out at the beginning of the article:) ;)

Life expectancies continue to improve, however. For people diagnosed with HIV during 2006-08 who have maintained a CD4 count of over 200, life expectancy at age 20 is now equal to that in the general population.

nychope1

  • Guest
Re: More reason to start treatment early...
« Reply #17 on: December 03, 2010, 12:11:13 AM »
That article should be its own thread.

Offline wtfimpoz

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Re: More reason to start treatment early...
« Reply #18 on: December 03, 2010, 01:34:11 AM »
Interesting article on this topic. Those of us who are newly infected should read past the first couple of paragraphs before freaking out, though:


HIV in the UK still cuts 13 years off life expectancy: late testing is the main reason


http://aidsmap.com/news/HIV-in-the-UK-still-cuts-13-years-off-life-expectancy-late-testing-is-the-main-reason/page/1558930/

(in case you decided to freak out at the beginning of the article:) ;)

Life expectancies continue to improve, however. For people diagnosed with HIV during 2006-08 who have maintained a CD4 count of over 200, life expectancy at age 20 is now equal to that in the general population.


Of course, quality of life is still dubious  :-\, or as one nurse put it to me, "you'll be in a nursing home in thirty years" (I was 28 at the time).  Before we embrace undue optimism, remeber these are mathematical projections with little regard for the unforseen long-term consequences of the virus. 

edited for elaboration
« Last Edit: December 03, 2010, 01:37:31 AM by wtfimpoz »
09/01/2009-neg
mid april, 2010, "flu like illness".
06/01/2010-weakly reactive ELISA, indeterminant WB
06/06/2010-reactive ELISA, confirmed positive.

DATE       CD4     %     VL
07/15/10  423     33    88k
08/28/10  489     19    189k
09/06/10-Started ATRIPLA
09/15/10  420     38    1400
11/21/10  517     25    51

 


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