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Author Topic: Isn't it time to just start treating everyone?  (Read 12294 times)

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Offline buginme2

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Isn't it time to just start treating everyone?
« on: May 13, 2011, 05:23:56 PM »
More and more articles that have been published lately have been recommending treatment earlier and earlier.  Recently an article was published that stated those who started treatment early were 96% less likely to transmit HIV.

http://www.aidsmeds.com/articles/hiv_treatmentasprevention_hptn052_1667_20423.shtml

Another article I read today states that people who experience a slow decline in CD4's.  Who historically have been told they can delay treatment until their CD4's reach a number of either 500 (U.S) or 350 (Europe) would benefit if they started treatment earlier because once they reach that number they have a harder time rebuilding lost CD4's.

http://www.medscape.com/viewarticle/742082?src=nl_topic

In addition, all of the research that has stated it could be beneficial to start treatment earlier to prevent HIV from developing large reservoirs.  It seems more and more research is advising to start treatment right away.  Why are we still delaying treatment? 

Offline mecch

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Re: Isn't it time to just start treating everyone?
« Reply #1 on: May 13, 2011, 05:59:07 PM »
I think you have misunderstood or misread the article about 96% less likely to transmit.

That is to say, it doesn't matter if you have 0 tcells, and start HAART after 15 years HIV+.  Once you are undetectable you are not very likely to transmit.

So you can start early and you won't transmit once you are undetectable. You can start very late and you won't transmit. 

The point of that research was about how if you are not on HAART, of course you have a transmissible disease.
« Last Edit: May 13, 2011, 06:07:45 PM by mecch »
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline buginme2

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Re: Isn't it time to just start treating everyone?
« Reply #2 on: May 13, 2011, 06:45:15 PM »
Yes I get that. Thats not my point. My point was article after article tells of the virtues of starting treatment right away. I cant remember ever reading an article that said research showed it was benefitial to delay treatment.  Yet we still tell people, doctors and those on this forum to delay treatment. 

Offline phildinftlaudy

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Re: Isn't it time to just start treating everyone?
« Reply #3 on: May 13, 2011, 06:50:20 PM »
I think one of the more important things the article also mentions clearly is that CONDOMS are still necessary for prevention to truly be effective. 

While the article makes a good argument for providing treatment - and we can only hope that it may open the eyes of some of those in political power who control the purse strings on programs such as ADAP, as well as those pharmaceutical company executives who control the prices of life-saving drugs; insurance companies, etc - it is still imperative that the greater responsibility for using condoms keeps getting out. 
September 13, 2008 - diagnosed +
Labs:
Date    CD4    %   VL     Date  CD4  %   VL
10/08  636    35  510   9/09 473  38 2900  12/4/09 Atripla
12/09  540    30    60   
12/10  740    41  <48   
8/11    667    36  <20  
03/12  1,041  42  <20
05/12  1,241  47  <20
08/12   780    37  <20
11/12   549    35  <20
02/12  1,102  42  <20
11/12   549    35  <20

Offline Matty the Damned

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Re: Isn't it time to just start treating everyone?
« Reply #4 on: May 13, 2011, 06:56:27 PM »
Yes I get that. Thats not my point. My point was article after article tells of the virtues of starting treatment right away. I cant remember ever reading an article that said research showed it was benefitial to delay treatment.  Yet we still tell people, doctors and those on this forum to delay treatment. 

What do you mean by beneficial? There can be reasons to delay treatment in individual cases that are not necessarily related to VL and CD4 count.

MtD

Offline leatherman

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Re: Isn't it time to just start treating everyone?
« Reply #5 on: May 13, 2011, 07:57:24 PM »
Why are we still delaying treatment? 
don't forget that many people do have various side effects. None of the current meds work 100% with no side effects for everyone. Treating everyone may reduce transmission but you'll be putting a lot of people at risk for heart, liver and bone issues.

and discussing side effects, we must consider the long term effects. As no one has been on Atripla for 40 yrs, we only have data projecting what results might come from 40 yrs of Atripla use. As the science has constantly been evolving through the last 3 decades, we've all been and still are guinea pigs as to the effectiveness of all this chemotherapy.

and finally, as in every situation, "follow the money". Who is going to pay to treat everyone? As of May 5th, there were 7,873 Americans who met the requirements for treatment yet were unable to get funding, and are not being treated.

Actually that's not 100% true though as some of those people are being totally funded by ASOs and donor contributions; but those are only temporary stop-gap measures. Many of those people are actually going without medication even though they are are past the "treat early" stage and below the <350 guideline.
leatherman (aka mIkIE)


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Offline Hellraiser

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Re: Isn't it time to just start treating everyone?
« Reply #6 on: May 13, 2011, 09:54:19 PM »
Yet we still tell people, doctors and those on this forum to delay treatment. 

I am all for commencing treatment at diagnosis, but that is by no means a 100% ringing endorsement of treatment at diagnosis for one and all.  I think that the meds have come a long way and now you're better off starting them than going without.   The only thing I've seen come out of everyone's posts here is "consult with your doctor" it may of course be prefaced by "If I were in your position" or "In my experience", but we're not trained professionals or a group with a single goal or mindset.

Offline mecch

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Re: Isn't it time to just start treating everyone?
« Reply #7 on: May 13, 2011, 10:13:05 PM »
Yes I get that. Thats not my point. My point was article after article tells of the virtues of starting treatment right away. I cant remember ever reading an article that said research showed it was benefitial to delay treatment.  Yet we still tell people, doctors and those on this forum to delay treatment.  

You dont seem to get that you are confounding apples and oranges.  

Apples:  Treatment as prevention:  there is a societal benefit to treatment as prevention.  Less HIV is transmitted.  This is not an argument that it helps HIV+ people's health.   Furthermore, the NIH study more or less repeats the research announced in the Swiss Statement 3 years ago and is about prevention in couples.  What's more, the PrEP people are trying to piggyback on this NIH statement with some pretty shaky lines of reasoning.

Personally I like the idea of treatment as prevention but its a political and moral idea.

Oranges:  Early treatment is better for an HIV+ person's long-term prognosis.  The research to absolutely prove that is NOT in yet.  Thus the current protocals.   Which are, contrary to your statement, based on years of experience and research.  

There are arguments for and against early treatment.  You'll find doctors in one camp or the other - about the cost/benefit of early treatment.  Furthermore I am sure you'll find any one doctor who sees benefits for some patients and not for others.  Thus the recommendation in this forum that it should be an informed decision between patient and doctor and therefore by extension between doctor and medical science.

While I personally am persuaded by the benefits of both apples and oranges (and kind of agree with you - its a goal to be able to treat everyone early) -- I do recognise that things are the way they are now for economic, political and moral reasons, and also because of the medical research and experience so far.  Remember - first do no harm.

You seem to want something simple and universal and its not either.  Right?
« Last Edit: May 13, 2011, 10:16:38 PM by mecch »
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline buginme2

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Re: Isn't it time to just start treating everyone?
« Reply #8 on: May 14, 2011, 12:10:24 AM »
Of course I want something simple and universal.  It seems as though (from my non-expert eyes) that we (the U.S) are moving slowly in the direction of treating everyone straight away.  I have been reading over and over the benefits of starting treatment early.  I was making the point because it seems like I am always reading a new article about the benefits of starting treatment sooner rather than later.  It seems like more and more evidence is supporting that. 



Offline spacebarsux

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Re: Isn't it time to just start treating everyone?
« Reply #9 on: May 14, 2011, 01:34:28 AM »
This is my understanding:- While there appears to be growing evidence that starting treatment early is likely to be beneficial (in terms of bringing viral load to UD levels), it is NOT YET PROVEN that this would INFACT pan out in practice (i.e. the overall health of the patient will be better in the LONG TERM due to early initiation of ART).

At this point no one really knows FOR CERTAIN whther starting treatment at too early a stage will be beneficial in the LONG TERM. Reliance on data and statistics can never be 100% accurate, nor can its reliance be placed in every situation. For a host of reasons, for many patients the long term side effects of the drugs (not to mention resistance issues) etc MAY outwiegh the potential benefits of initiating therapy to early.

It all comes down to which is the lesser of the two evils- the adverse consequences (long term and short term) of unchecked viral multiplication WITH A HEALTHY CD4 COUNT or the adverse consequences (long term and short term) of having an Undetectable Viral Load at an early stage with CD4 above 500 at the cost of potnent ARVs circulating in your blood.

 I don't think anyone has come up wiht a SCIENITIFICALLY PROVEN, clear, unequivocal answer. If they have, please tell me what it is.
Infected-  2005 or early 2006; Diagnosed- Jan 28th, 2011; Feb '11- CD4 754 @34%, VL- 39K; July '11- CD4 907@26%,  VL-81K; Feb '12- CD4 713 @31%, VL- 41K, Nov '12- CD4- 827@31%

Offline tednlou2

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Re: Isn't it time to just start treating everyone?
« Reply #10 on: May 14, 2011, 02:03:44 AM »
I wish the START study was already done, so that we'd have a better idea which path is best.  I thought it was already in progress and had run into problems.  But, I just read an article saying researchers were gathering participants now for the study.  Did START already start?  I get all these studies confused. 

Offline mecch

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Re: Isn't it time to just start treating everyone?
« Reply #11 on: May 14, 2011, 05:28:38 AM »
All I'm saying is that it seems to me, that some of you, are misusing treatment as prevention research -- thinking it has something to say about early treatment being a benefit to the HIV+ person.  Treatment as prevention helps prevent new infections.  

Just don't confuse the two issues and the two sets of research.  Even if you think both are good ideas.

« Last Edit: May 14, 2011, 05:33:01 AM by mecch »
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline buginme2

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Re: Isn't it time to just start treating everyone?
« Reply #12 on: May 14, 2011, 07:28:01 PM »
All I'm saying is that it seems to me, that some of you, are misusing treatment as prevention research -- thinking it has something to say about early treatment being a benefit to the HIV+ person.  Treatment as prevention helps prevent new infections.  

Just don't confuse the two issues and the two sets of research.  Even if you think both are good ideas.



I am certainly not trying to equate the two however, if starting treatment early reduces transmissions by 96% as the recent study stated AND starting treatment early also has a beneficial effect on the patient, such as the information from the other study I posted, then why are we still debating the topic of starting early?

Offline Assurbanipal

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Re: Isn't it time to just start treating everyone?
« Reply #13 on: May 14, 2011, 08:01:59 PM »
I am certainly not trying to equate the two however, if starting treatment early reduces transmissions by 96% as the recent study stated AND starting treatment early also has a beneficial effect on the patient, such as the information from the other study I posted, then why are we still debating the topic of starting early?

The most important remaining issue (if one assumes away the need to see if starting early really is beneficial) is adherence.  If someone starts but is half hearted about taking the pills they can wind up buning through the most tolerable drugs for themselves, and potentially spreading resistance to sex partners.  And the start-up phase for the pills is often pretty difficult, even if it goes away over time.

 If someone is in really bad shape, it may make sense to get them to start even if they are not 100% committed -- many of them will commit after they feel the improvement in health.



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 richie

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Re: Isn't it time to just start treating everyone?
« Reply #14 on: May 15, 2011, 12:34:20 AM »
I hate to blow a hole in the story (treat everyone, get rid of infection), but I will.  Clearly, the article states that those on therapy have little risk of passing on HIV.  But there is a large percentage of people with HIV who don't know it, and don't care.  They don't get tested.  They list their stats online as "HIV = "Don't Know"", which I take to mean "don't care."  THESE are the most infectious people most probably with high VLs, and if not tested and treated, will continually spread HIV.   Eventually, they'll get sick and get treated, removing themselves from the infectious pool.  But the 100 people THEY infected are infecting 1000's more, and so on and so on. 

So condoms and behaviour will always be front and center of prevention.   And taking Truvada as a preventive measure (with a 44% success rate) means 56% of the time infection will be passed, but the drug companies will still get their increased revenue (at $12,000 per patient per year).  And of course, probaby passing on HIV with resistance to Truvada to boot.  Arrrrggggh. 


Online Miss Philicia

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Re: Isn't it time to just start treating everyone?
« Reply #15 on: May 15, 2011, 01:29:12 AM »
Test & Treat doesn't work for multiple reasons.  It's not just the multitudes of individuals who are sexually active and neglect to get an HIV test for a decade until they're left with 8 t-cells, having infected hundreds of other people by that time.

25% of newly-diagnosed individuals were not successfully linked to HIV care within six-twelve months of their diagnosis, and between 10%-20% of patients remained unengaged in care three to five years after their diagnosis.
"I’ve slept with enough men to know that I’m not gay"

Offline tednlou2

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Re: Isn't it time to just start treating everyone?
« Reply #16 on: May 15, 2011, 03:00:22 AM »
Test & Treat doesn't work for multiple reasons.  It's not just the multitudes of individuals who are sexually active and neglect to get an HIV test for a decade until they're left with 8 t-cells, having infected hundreds of other people by that time.

25% of newly-diagnosed individuals were not successfully linked to HIV care within six-twelve months of their diagnosis, and between 10%-20% of patients remained unengaged in care three to five years after their diagnosis.

I keep reading this is a big problem with younger people (18-30, or so) and with minorities.  The younger people dx'd either feel invincible or don't take charge of the situation--like many younger people mess up their credit not thinking about the future.  I read many will get that dx, maybe go to the doc once or twice, and then drop out of care--if the even go for care once or twice. 

Offline mecch

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Re: Isn't it time to just start treating everyone?
« Reply #17 on: May 15, 2011, 06:23:52 AM »
I am certainly not trying to equate the two however, if starting treatment early reduces transmissions by 96% as the recent study stated AND starting treatment early also has a beneficial effect on the patient, such as the information from the other study I posted, then why are we still debating the topic of starting early?

Listen this is the third time you have confounded the two different research topics.   

The study is about how to prevent infections between sero-discordant couples.  An HIV+ person could be 5 months with the virus, or 15 years.  If he or she goes on HAART, the possibility of transmission goes down.  That's the extrapolation to make.

"The early treatment group" in the study is a misnomer. ALL the study participants 350-500 CDç at the start.  "Early" here means early in the study.  Some of those could have had HIV for many years.  Thus, not "early" in their individual HIV infection.  Early also means "early in the window of protocal" for starting treatment.  That is NOT again, early in a person's HIV infection.

This study has only proved that treatment helps prevent infection.  

Thats a good thing.
« Last Edit: May 15, 2011, 06:29:45 AM by mecch »
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline mecch

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Re: Isn't it time to just start treating everyone?
« Reply #18 on: May 15, 2011, 06:37:29 AM »
You know, with sound-bite transmission of HIV-transmission research, we could find ourselves in a flip flopped tight place.

I mean here we are today, HIV+ people wondering why the governments of the world can't get it together to treat all HIV+ people, when we need it, with some pills that are on the market.   

What if some government says, oh, treatment DOES equal prevention so all HIV must be treated.

Its pretty damn important to say that condoms, safer sex, prevent transmission.

That NIH summary doesnt even go into what actual practices, safe or unsafe, resulted in which transmissions of HIV. 
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline leatherman

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Re: Isn't it time to just start treating everyone?
« Reply #19 on: May 15, 2011, 09:42:07 AM »
I read many will get that dx, maybe go to the doc once or twice, and then drop out of care--if the even go for care once or twice. 
The ASO/clinic I go to has a full time and a part time case manager whose duty is only to track down our "missing" clients. Poor adherence not only comes from a youthful naiveté but things like drug addiction, alcoholism, homelessness, and mental health issues all get in the way. Getting HIV doesn't change any of the underlying problems people may have been dealing with. Since risk behavior and personal problems can play a part in getting infected, risk behavior  and personal problems can play a part in how well a client treats theirself after infection.
leatherman (aka mIkIE)


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

Offline buginme2

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Re: Isn't it time to just start treating everyone?
« Reply #20 on: May 15, 2011, 12:32:05 PM »
Mech did you read the study?  The 96% reduction in transmission were from those who started treatment shortly after seroconversion.  As people delayed treatment their transmission rate went up, even after starting haart. 

Offline buginme2

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Re: Isn't it time to just start treating everyone?
« Reply #21 on: May 15, 2011, 12:34:19 PM »
And taking out the treatment as prevention part out of the equation that still doesnt change the fact that starting treatment earlier has a benefitial impact on the health of the patient, even in those with a slow cd4 decline. As the 2nd study suggested.

Offline buginme2

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Re: Isn't it time to just start treating everyone?
« Reply #22 on: May 15, 2011, 12:38:40 PM »
The only real argument against it is that "people dont care." I get that. We may not be able to get people to test and treat. That might never change. But what about everyone else? Everyone else who does test positive. Why then do they not go on treatment? Side effects? Buck I up say.

Offline mecch

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Re: Isn't it time to just start treating everyone?
« Reply #23 on: May 15, 2011, 04:50:43 PM »
Mech did you read the study?  The 96% reduction in transmission were from those who started treatment shortly after seroconversion.  As people delayed treatment their transmission rate went up, even after starting haart. 
Ah OK.  Where can I read the study? I just read the summary on the link provided. It didn't say that in the summary.
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline mecch

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Re: Isn't it time to just start treating everyone?
« Reply #24 on: May 15, 2011, 04:51:38 PM »
And taking out the treatment as prevention part out of the equation that still doesnt change the fact that starting treatment earlier has a benefitial impact on the health of the patient, even in those with a slow cd4 decline. As the 2nd study suggested.
Agree with you here.
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline Matty the Damned

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Re: Isn't it time to just start treating everyone?
« Reply #25 on: May 15, 2011, 05:19:16 PM »
But what about everyone else? Everyone else who does test positive. Why then do they not go on treatment? Side effects? Buck I up say.

Many people don't start treatment because for one reason or another THEY DON'T HAVE ACCESS TO FUCKING TREATMENT.

MtD

Offline mecch

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Re: Isn't it time to just start treating everyone?
« Reply #26 on: May 15, 2011, 05:29:14 PM »
MTD gives a great and basic reason.
And there is a good list of many other reasons everyone HIV+ doesn't go on treatment.
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline Ann

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Re: Isn't it time to just start treating everyone?
« Reply #27 on: May 15, 2011, 05:48:50 PM »
Everyone else who does test positive. Why then do they not go on treatment? Side effects? Buck I up say.

Wake up and smell the coffee, Bug. There are nearly 8,000 people in eleven states on ADAP waiting lists and most of these people are people who are in clinical need of meds - not people with new infections wanting to start early.

If the politicians cannot care enough to fund hiv meds for people who actually need them, what makes you think they're going to fund early treatment for health benefits?

If they don't give a shit about people who are already living with hiv, why do you think they're going to give a shit about those who may be at risk for infection? They're not going to fund people going on meds to prevent onward prevention any more than they're going to fund crackhouses. They lump us all in the same category, after all.

Buck that up.
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"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

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HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline buginme2

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Re: Isn't it time to just start treating everyone?
« Reply #28 on: May 15, 2011, 06:40:26 PM »
8000 people are on adap waiting lists in the U.S.  That is .008 percent of the people in the U.S. that are HIV positive. I understand that there are some people who cannot obtain meds.  The majority of people in the U.S. who are in clinical need obtain it. However, that is not the point at all.  The point is that the U.S. recommends people not even start treatment until their cd4's reach 500 and its even lower in Europe when there is evidence after evidence that states they should be starting asap for both the health of the patient and as a public health benefit.

Offline phildinftlaudy

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Re: Isn't it time to just start treating everyone?
« Reply #29 on: May 15, 2011, 06:46:54 PM »
8000 people are on adap waiting lists in the U.S.  That is .008 percent of the people in the U.S. that are HIV positive. I understand that there are some people who cannot obtain meds.  The majority of people in the U.S. who are in clinical need obtain it. However, that is not the point at all.  The point is that the U.S. recommends people not even start treatment until their cd4's reach 500 and its even lower in Europe when there is evidence after evidence that states they should be starting asap for both the health of the patient and as a public health benefit.
This still doesn't address Ann's point
"If the politicians cannot care enough to fund hiv meds for people who actually need them, what makes you think they're going to fund early treatment for health benefits?"

Making the cd4 levels higher to begin treatment (above 500 for the US) would cost money that the politiicans and insurance companies are not going to support.  There are lots of things that make sense in the sense of improving public health and lowering risks to others - that doesn't mean that they ever get implemented.


September 13, 2008 - diagnosed +
Labs:
Date    CD4    %   VL     Date  CD4  %   VL
10/08  636    35  510   9/09 473  38 2900  12/4/09 Atripla
12/09  540    30    60   
12/10  740    41  <48   
8/11    667    36  <20  
03/12  1,041  42  <20
05/12  1,241  47  <20
08/12   780    37  <20
11/12   549    35  <20
02/12  1,102  42  <20
11/12   549    35  <20

Online Dachshund

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Re: Isn't it time to just start treating everyone?
« Reply #30 on: May 15, 2011, 06:47:22 PM »
8000 people are on adap waiting lists in the U.S.  That is .008 percent of the people in the U.S. that are HIV positive. I understand that there are some people who cannot obtain meds.  The majority of people in the U.S. who are in clinical need obtain it. However, that is not the point at all.  The point is that the U.S. recommends people not even start treatment until their cd4's reach 500 and its even lower in Europe when there is evidence after evidence that states they should be starting asap for both the health of the patient and as a public health benefit.

The problem isn't the people who know, it's the people who don't know. So buck the fuck up and wear a condom.

Offline CaptCarl

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Re: Isn't it time to just start treating everyone?
« Reply #31 on: May 15, 2011, 10:49:43 PM »
The only real argument against it is that "people dont care." I get that. We may not be able to get people to test and treat. That might never change. But what about everyone else? Everyone else who does test positive. Why then do they not go on treatment? Side effects? Buck I up say.

One imagines that it would have something to do with an INABILITY TO ACCESS MEDS! It's a great idea and all, but not a very practical one. Like others have pointed out, there is a serious ADAP crisis going on all over the country. They can't even keep the people who truly need these meds supplied, how in the Hell will they be able to afford paying for still more meds to be used on people who are newly infected and as a result, still have an immune system that is basically complete? When you have limited supplies, those supplies should rationally go to the ones most in need of them, not the ones with the least need.

Since, in another posting in another topic, you said you were rich, maybe it's time for you to Buck Up and throw down some money to help further the cause that you clearly feel so strongly about. Time to walk The Walk there, Lil' Buddy...

CaptCarl
The only thing I can do straight is shoot..

Offline buginme2

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Re: Isn't it time to just start treating everyone?
« Reply #32 on: May 16, 2011, 12:00:39 AM »
I'm amazed at how the suggestion that we should expand treatment to include more people is somehow controversial.  Ok, I give up the fight.  Let them go without.  I've got mine, right?

And CaptKangaroo don't begin to think I don't throw my money down in some very worthy places.  How about you?  I guess thats hard to do when your taking instead of giving.
 

Offline woodshere

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Re: Isn't it time to just start treating everyone?
« Reply #33 on: May 16, 2011, 12:14:26 AM »
And CaptKangaroo don't begin to think I don't throw my money down in some very worthy places.  How about you?  I guess thats hard to do when your taking instead of giving.
 

Completely uncalled for!  I don't know the income of you or any other member and frankly don't care.  But your comment is insulting.  Many have no choice than to depend on ADAP or other government assistance in order to survive.  Your comment shows how shallow an individual you are.

"Let us give pubicity to HV/AIDS and not hide it..." "One of the things destroying people with AIDS is the stigma we attach to it."   Nelson Mandela

Offline David Evans

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Re: Isn't it time to just start treating everyone?
« Reply #34 on: May 16, 2011, 12:21:22 AM »
Bug,

That was totally uncalled for. You started a thread and you got responses - just perhaps not the responses you wanted to hear. Refrain from the character attacks please, or you'll be given a formal warning.

David
Moderator

Offline thunter34

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Re: Isn't it time to just start treating everyone?
« Reply #35 on: May 16, 2011, 12:23:56 AM »
Damn, that's some good moderatin' right there.  Zoomed in before my sleepy ass could even type up my indignation.

But yeah:    >:(
AIDS isn't for sissies.

Online Jeff G

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Re: Isn't it time to just start treating everyone?
« Reply #36 on: May 16, 2011, 01:14:07 AM »
I think its important to remember that many of us that are on disability and or ADAP give back to those in need how and when ever we can , it may be volunteering or in the form of money when we can afford to do so . Most of the people I know that have been helped when they needed it find ways to quietly give back without making a show of it .

Being on the receiving end of aid is a very humbling experience , I see no reason why it cant also be humbling to give it .    

Offline sfpvguy41

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Re: Isn't it time to just start treating everyone?
« Reply #37 on: May 16, 2011, 01:53:57 AM »
Isnt it time the US stops playing enabler to the drug companies, and buy well made generic HIV drugs for a fraction of the cost as they do in India and Africa for example (the US even buys these for distribution in Africa) and get them to 100% of our own people who need them, with existing funding???
Labs: (undetectable since 2005)
12/13: 634 cdr, 37.3%, 758 cd8, total chol 183, triglycerides 131
8/13: changed to Edurant from Reyataz
12/12: 828 cd4, 34.5%, 1078 cd8, total chol 192, tri 196
12/11: 787 cd4, 37%, 979 cd8.
9/11: 758 cd4, 38%, 944 cd8, und.
8/11 dropped norvir, incr reyataz to 400 mg
6/11: 621 CD4 CD4% 41, CD8 680! Undetectable. Creatinine and eGFR are ok now.
Switched from Truvada to Epzicom in late April 2011
AGT/AST and creatinine back to normal mid-April.
Cut Norvir from regimen.
Switched back to Reyataz/Norvir late Feb 2011
2/11: CD4 664 34%, CD8 963, diagnosed with osteoporosis, high AGT/AST and creatinine.
12/10: CD4: 676 CD4%: 34 CD8: 1012
Switched from Reyataz/norvir to Isentress 10/10
8/10: CD4: 731 CD4%: 40 CD8: 866
Diagnosed Sept. 2002 started meds May 2005.

Offline spacebarsux

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Re: Isn't it time to just start treating everyone?
« Reply #38 on: May 16, 2011, 02:52:53 AM »
If one were to NOT take into consideration the cost of early treatment and other such practicalities and exigencies and rely SOLELY on the SCIENTIFIC EVIDENCE regarding the potential health benefits of early initiation of HAART notwithstanding a healthy CD4 (i.e. > 500), is it OVERWHELMINGLY AND CONCLUSIVELY proven that early treatment WILL BE BETTER FOR THE LONG TERM HEALTH OF THE PATIENT?

Some things just seem a little confusing. How can anyone know FOR SURE what the long term effects of Atripla or Isentress or any of the other drugs would be, after say 15-20 years of consistent use? The patient may have an undetectable viral load but what about the condition of the liver, kidneys and other organs? WILL THE OVERALL HEALTH STILL BE BETTER IN THE LONG TERM?

And how much weight do the WHO Guidelines on starting treatment, the EU Guidelines, the USA Guidelines and the Guidelines here in India (which all say to wait to start treatment until CD4 drops to 350 or 500), put on saving money?

The answers to all of these questions are very conflicting depending on whom you ask. However, all doctors that I have asked have told me TO WAIT before initiating therapy as I can afford to do so with a CD4 > 500, at this stage.


Infected-  2005 or early 2006; Diagnosed- Jan 28th, 2011; Feb '11- CD4 754 @34%, VL- 39K; July '11- CD4 907@26%,  VL-81K; Feb '12- CD4 713 @31%, VL- 41K, Nov '12- CD4- 827@31%

Offline CaptCarl

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Re: Isn't it time to just start treating everyone?
« Reply #39 on: May 16, 2011, 06:03:16 AM »
And CaptKangaroo don't begin to think I don't throw my money down in some very worthy places.  How about you?  I guess thats hard to do when your taking instead of giving.

It's refreshing to know that a person of means such as yourself is willing to throw your money down for worthy causes. I guess it just comes down to how much money, and what constitutes a worthy cause.

How about me? Hmmmm, let's see. I have been active in fundraising for several organizations. Helping with the events planning, booking spaces, soliciting donations. Trivial things of that nature. I have goten involved with transplant organizations, healthcare for the homeless, and animal shelters. Our most recent fundraiser was for the county animal shelter where I live. We collected over $5,000 in addition to over 500 pounds of dog/cat/horse food. When the shelter had to move it's location, I got a group of 15 volunteers to help with the rennovation of the new facility, as well as the actual moving of critters and equipment. In the last 2 years, I have spearheaded and been actively involved in campaigns that have raised, in totality, just under $100,000.

My curent project is starting to get a scholarship fund started and sustained for HIV+ college students. We are hoping to have $10K by the end of the year, though I think that may be a bit optimistic right now.

So even though I make very little money, and haven't had a raise in four years due to budget cuts, I do donate my time in an attempt to leave the world a better place than when I found it. I even work in job I hate so that I have health insurance, thereby allowing someone else access to serviced they might not otherwise be able to receive.

Anything else? Or that about cover it?

Capt Kangaroo

The only thing I can do straight is shoot..

Offline anniebc

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Re: Isn't it time to just start treating everyone?
« Reply #40 on: May 16, 2011, 06:54:31 AM »
Captain Kangaroo, you don't mind if I call you that do you, after all I still call Australia home.. ;)

You are a man worth his weight in gold..and I challenge anyone who doesn't agree with me.. ;D

Aroha always
Jan :-*
-----------------------------------------------------------------------
Never knock on deaths door..ring the bell and run..he really hates that.

Offline skeebo1969

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Re: Isn't it time to just start treating everyone?
« Reply #41 on: May 16, 2011, 07:18:54 AM »
And CaptKangaroo don't begin to think I don't throw my money down in some very worthy places.  How about you?  I guess thats hard to do when your taking instead of giving.
 


   Just wow, not only is this an attack of character..but it is also a disgusting jab at anyone who is unfortunate enough to have to draw disability.  Not to cool at all, buginme2....


 
I despise the song Love is in the Air, you should too.

Offline Rev. Moon

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Re: Isn't it time to just start treating everyone?
« Reply #42 on: May 16, 2011, 08:32:54 AM »
It's refreshing to know that a person of means such as yourself is willing to throw your money down for worthy causes. I guess it just comes down to how much money, and what constitutes a worthy cause.


Good point, Carl.  For all we know Miss Bug is "throwing" (I also have an issue with the use of this word when referring to charity or donations) twenty bucks at the local crack house or a Benjamin at some street hustler named Dwayne.  What defines a "worthy place" --notice that he did not say "worthy causes"-- for one person is not the same for the next individual.

Amazing how someone can manage to offend so many people in just one little line or two.
"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 metekrop

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Re: Isn't it time to just start treating everyone?
« Reply #43 on: May 16, 2011, 10:52:18 AM »

Another article I read today states that people who experience a slow decline in CD4's.  Who historically have been told they can delay treatment until their CD4's reach a number of either 500 (U.S) or 350 (Europe) would benefit if they started treatment earlier because once they reach that number they have a harder time rebuilding lost CD4's.


Why is the difference b/n HIV in US (500) and EU. (350).  May it mean that HIV is more severe in US than Europe.  :P
« Last Edit: May 16, 2011, 11:02:24 AM by metekrop »
Diag on Dec 8, 2000, CD 440 VL 44K, No Meds
Dec/08 - Feb/09 CD< 50 & VL >500k hosp'z.
St. Atripla - July/09 CD 179, VL 197k
Oct/09 CD 300 VL UD Chol 267
Mar/10 CD 468 UD, Ch 220
Aug/10 CD 460 UD, Ch 195
Dec/10 CD 492 UD, Ch 172
Mar/11 CD 636 UD, Ch 201
Aug/11 CD 530 UD, Ch 98
Jan/12 cd 616 UD, ch 189
Jul/12 CD 640 UD, Ch ?
Dec/12 CD 669 Ud, Ch 125
May/7 CD711 Ud, Ch?
Nov/ 22 663 UD, Ch,
April 17 CD 797, UD

Offline Joe K

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Re: Isn't it time to just start treating everyone?
« Reply #44 on: May 16, 2011, 10:59:02 AM »
I think its important to remember that many of us that are on disability and or ADAP give back to those in need how and when ever we can , it may be volunteering or in the form of money when we can afford to do so . Most of the people I know that have been helped when they needed it find ways to quietly give back without making a show of it .

Being on the receiving end of aid is a very humbling experience , I see no reason why it cant also be humbling to give it .    

Very well said.  Still waters are often very deep.

Offline Ann

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Re: Isn't it time to just start treating everyone?
« Reply #45 on: May 16, 2011, 11:05:39 AM »
Why is the difference b/n HIV in US (500) and EU. (350).  May it mean that HIV is more severe in US than Europe.  :P

No, it just means that the European treatment guidelines are more conservative when it comes to initiating treatment than the US treatment guidelines.
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"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Online Miss Philicia

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Re: Isn't it time to just start treating everyone?
« Reply #46 on: May 16, 2011, 11:10:56 AM »
Naw, it's just cuz the Evil Eurosocialists are skimping.
"I’ve slept with enough men to know that I’m not gay"

Offline Assurbanipal

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Re: Isn't it time to just start treating everyone?
« Reply #47 on: May 16, 2011, 11:17:17 AM »
Why is the difference b/n HIV in US (500) and EU. (350).  May it mean that HIV is more severe in US than Europe.  :P

And actually the US and EU guidelines are closer together than you would guess by just reading the headline on the EU guide. 

In the details the EU guide says:
"CD4 < 350: treatment recommended.
• CD4 350-500:
-- Treatment recommended if hepatitis C coinfection, hepatitis
B coinfection requiring therapy, HIV-associated nephropathy
or other specific organ deficiency, age > 50, pregnancy or
malignancy.
-- Treatment should be considered for viral load (VL) > 105 c/ml
or high cardiovascular risk
• CD4 > 500:
-- Treatment should generally be deferred, independently of
plasma HIV RNA; closer follow-up of CD4 if VL > 105 c/ml
-- Treatment can be offered if presence of the above
co-morbidities (see CD4 350-500)
• Regardless of CD4 count or VL CD4 and Plasma HIV RNA,
treatment can be offered on an individual basis, especially if
patient is seeking and ready for ARV therapy and/or for any
personal reasoning including being part of a serodiscordant
relationship as part of risk reduction."

http://www.europeanaidsclinicalsociety.org/guidelinespdf/1_Treatment_of_HIV_Infected_Adults.pdf

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 Ann

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Re: Isn't it time to just start treating everyone?
« Reply #48 on: May 16, 2011, 11:42:09 AM »
And actually the US and EU guidelines are closer together than you would guess by just reading the headline on the EU guide. 

Yes, they are very close. In most European countries, health care is ether entirely socialised or much more socialised than the US. At least we don't have to worry about where our health care or meds is going to come from when we need it.

Naw, it's just cuz the Evil Eurosocialists are skimping.

At least we don't have to worry about where our health care or meds is going to come from when we need it. :P


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"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline mecch

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Re: Isn't it time to just start treating everyone?
« Reply #49 on: May 16, 2011, 02:32:26 PM »
• Regardless of CD4 count or VL CD4 and Plasma HIV RNA,
treatment can be offered on an individual basis, especially if
patient is seeking and ready for ARV therapy and/or for any
personal reasoning including being part of a serodiscordant
relationship as part of risk reduction."

Ask and you get it.
Turn positive in certain cities they seem to encourage it on you.

No cuts on Euro-socialists, please!  Hope the systems here continue to work for many years.  Beats all the fucking hassle in the US, one of the richest countries and most advanced countries in the world.
“From each, according to his ability; to each, according to his need” 1875 K Marx

 


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