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Author Topic: Balancing health and medication options.  (Read 2894 times)

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Offline testii28

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Balancing health and medication options.
« on: December 31, 2024, 07:20:26 pm »
I haven’t been active in the forum for a while, but I still come back occasionally to read updates about treatment options.

Over the past few months, I’ve had two questions that I haven’t been able to find satisfying answers to. I’m hoping someone here can help bring some light on these topics.

It’s often said that Hepatitis B can never be fully cured, leaving a residual viral load in the body. With that in mind, if someone has an HIV viral load of 1000–3000 levels that aren’t harmful to the body, why is there so much stress about it?
Honestly, I wouldn’t be too worried if my viral load went up to 1000. My main concern is HIV resistance, but Dolutegravir/Bikarvy has a high barrier makes it rare, though it can still happen if medication is stopped for weeks.

I’ve read about French studies suggesting alternative treatment schedules, like 4/7 or 5/7 . It’s clear that daily medication can lead to significant side effects, like heart problems, kidney issues, and high cholesterol. If someone claims otherwise it is just not true. In my case, I feel like I’m overdosing on medication and creating more problems for myself beyond just managing HIV.

I’ve developed high cholesterol, kidney issues (GFR 58), and I’m starting to experience heart problems. Personally, I’d rather have a slightly higher HIV viral load and take less medication than risk these long-term health complications. Changing my regimen (Biktarvy) it is not an option because most alternatives seem to cause similar issues over time. Switching to Dovato isn’t an option for me if I want to try a 4/7 or 5/7 dosing schedule because it’s a two-drug regimen.

I’d love to hear about others experiences.

« Last Edit: December 31, 2024, 07:59:44 pm by Jim Allen »

Offline leatherman

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Re: Balancing health and medication options.
« Reply #1 on: December 31, 2024, 08:23:58 pm »
It’s often said that Hepatitis B can never be fully cured, leaving a residual viral load in the body. With that in mind, if someone has an HIV viral load of 1000–3000 levels that aren’t harmful to the body, why is there so much stress about it?
be careful you're not conflating HepB and HIV. Those viral load amount are nothing like each other. Someone who has been UD and now has had several tests results in a VL of 1000-3000 range needs to speak to a doctor about resistance testing and perhaps a need for a regimen change asap. the rate HIV multiples is very high, and a small foothold can quickly become a terrible problem.

Quote
Honestly, I wouldn’t be too worried if my viral load went up to 1000
a one-off result? ? maybe. but multiple tests 1000 and up? I'd be worried and looking for a med change.

Quote
high barrier makes it rare, though it can still happen if medication is stopped for weeks.
resistance is not caused by stopping meds for a few weeks. That would be the exact plan to correctly stop meds. HIV develops resistance to the meds when the meds aren't not taken regularly, giving time for the meds level to slightly drop, allowing HIV to develop resistance.

here's something I've posted before:
Quote
Resistance (HIV mutating to resist a medication) mainly happens from not taking enough meds properly. The amount of virus has to drop to low levels, but not be totally absent, for the virus to mutate against the drug. In other words, someone who takes meds a few days, then skips a few, then takes it for a few more days sets themselves to have the levels of meds dip too low and HIV mutating before bringing the levels back up. Completely stopping meds usually doesn't cause resistance because the level of meds continue to drop well past any level to effect HIV before the HIV can mutate.

I took this chart from a site about antibiotics and edited it a little bit, so please ignore any weirdness there at the 2nd dose. The thing to take away is that any time adherence falls below the point (the red dashed line) of keeping the med level high enough (at least 95% adherence or higher*), resistance becomes possible.



Thankfully, the meds of today are much more effective. With a longer half-life (the amount of time the med is at the right level in your system), these meds stay in our systems longer, making incidents of non-adherence (skipping a dose) less likely to allow HIV to mutate. This is what allows a greater leeway (2-4 hrs) around the timing of each day's dose, or not developing resistance when missing a single dose in a month.

here's a good write-up about resistance from the San Fran AIDS foundation
https://www.sfaf.org/collections/beta/heres-what-you-need-to-know-about-hiv-drug-resistance/
and more info from poz.com
https://www.poz.com/basics/hiv-basics/hiv-drug-resistance

Quote
I’ve read about French studies suggesting alternative treatment schedules, like 4/7 or 5/7
Be cautious of reduced dosing schedules and 2-drug regimens. All of these things have been studied for years with mixed results, as the risks for resistance, high viral loads and sickness are much higher.

Quote
Personally, I’d rather have a slightly higher HIV viral load and take less medication than risk these long-term health complications.
sorry, but that's not how HIV treatment works. As someone who has lived with HIV 40 years, all I can tell you is the choice is between daily meds and side effects or death. Unfortunately that's the disadvantage of having a terminal illness.  ;) :'(
leatherman (aka Michael)

We were standing all alone
You were leaning in to speak to me
Acting like a mover shaker
Dancing to Madonna then you kissed me
And I think about it all the time
- Darren Hayes, "Chained to You"

Offline Jim

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Re: Balancing health and medication options.
« Reply #2 on: December 31, 2024, 08:29:21 pm »
Oranges and apples. HIV isn't HBV or Herpes for that matter and I think you are a few decades off with this train of thought.

Anyhow, no drama is needed, this is your first HIV treatment and you are pretty early into it. if this combination does not agree with your kidneys then switch, and manage the cholesterol and no, this current HIV combo hasn't damaged your heart. You simply do not need this drama or messing about and if you want to be healthier and reduce your risks for certain conditions like heart problems then focus on what you can control, a balanced diet, better sleep, exercise, cutting out bad habits and treating any issues early.

As for the balance you are looking for, its been found, the START study was overwhelmingly clear, leading to the "Treat all" area starting and being accepted globally, It showed that with daily HIV treatments, not only did the short-term survival rate increase but since then, the long-term health outcomes have shown to improve dramatically. Further studies have also demonstrated that even with low levels of HIV viral loads, so presitant high-100s to low 1000s have poorer health outcomes.

HIV meds are not perfect, nobody is claiming that, but since these studies started HIV meds have continued to develop and they have gotten even better, with fewer side effects and lower dosages and will continue to do so. I think the one pill a week, tailored daily dosages and non-superior long-lasting injectables are the next stages of development but we are not there yet.

If you currently have side effects, switch, it's not the 1990s and you get regular health screenings to pick up on any issues early and treat them, something most HIV-negative peers don't get.

Now, unfortunately, HIV meds do not fix all the damage or issues done before starting treatment, they simply suppress the virus and outcomes for those diagnosed and starting treatment early is generally better than for those starting treatment late /AIDS, so like in your case and mine. Even when starting early there are some ongoing issues that as a group we remain more prone to as we also have ongoing and persistent inflammation, etc. Additionally, genetics, potluck, lifestyle and other factors unrelated to HIV, of course, also play a major role.

References:

Quote
I’ve read about French studies suggesting alternative treatment schedules, like 4/7 or 5/7
Quote
Dovato isn’t an option for me if I want to try a 4/7 or 5/7 dosing schedule because it’s a two-drug regimen.

Atripla Taken Every Other Day
https://forums.poz.com/index.php?topic=72189.msg

4 Days a Week of Antiretroviral Treatment Enough?
https://forums.poz.com/index.php?topic=72799.msg

Discussion: Reduced-drug treatment (Biktarvy) 
https://forums.poz.com/index.php?topic=78049.msg

Dolutegravir resistance is rare, but some risk factors can up the odds (Dual & Mono therapy)
https://forums.poz.com/index.php?topic=77539.0

New HIV drugs with a higher resistance risk should be classed as inferior
https://forums.poz.com/index.php?topic=77560.msg



More evidence that integrase inhibitors don’t raise heart disease risk
https://forums.poz.com/index.php?topic=77491.msg

PROSPER-HIV trial - Weight gain, diet & exercise far from futile
https://forums.poz.com/index.php?topic=77556.msg
 
Long-Term Study Results Confirm Benefits of Early HIV Treatment
https://www.poz.com/article/longterm-results-confirm-benefits-early-hiv-treatment

http://www.who.int/mediacentre/news/releases/2015/hiv-treat-all-recommendation/en/
Anyone infected with HIV should begin antiretroviral treatment as soon after diagnosis as possible, WHO announced with its "treat-all" recommendation, WHO removes all limitations on eligibility for antiretroviral therapy (ART) among people living with HIV; all populations and age groups are now eligible for treatment.

The expanded use of antiretroviral treatment is supported by recent findings from clinical trials confirming that early use of ART keeps people living with HIV alive, healthier and reduces the risk of transmitting the virus to partners.[/b]

http://betablog.org/start-trial-shows-benefits-of-early-treatment-supports-art-for-all/
People who start antiretroviral therapy (ART) immediately after they are diagnosed with HIV, while their CD4 T-cell count is still high, have a lower risk of illness and death

https://www.poz.com/article/START-results-27299-8892
Gold-Standard Evidence Backs Early Treatment of HIV

http://www.medicalnewstoday.com/releases/285972.php?tw
"Delaying ART in patients with HIV reduces likelihood of restoring CD4 counts"

https://www.poz.com/article/Antiretrovials-Reduce-Cellular-Inflammation-Among-Elite-Controllers-of-HIV-23608-3878
Antiretrovials Reduce Cellular Inflammation Among Elite Controllers of HIV

https://www.poz.com/article/hiv-cardiovascular-elite-controllers-23015-5910
Cardiovascular Disease Risk Remains High in HIV Elite Controllers

"Elite Controllers Hospitalized More Often Than Those Treated For HIV"   
https://www.poz.com/article/elite-controllers-hospitalizations-26678-5093

Elite Controllers on average spent more than twice as many nights in hospital than people on ART, and about 50% more than people not on ART and with detectable viral loads. After adjusting for various differences between the EC and non-EC population, the study still found that ECs were 56% more likely to be admitted to hospital than people with undetectable viral loads on ART.

Elite Controllers Crowell TA et al. "Elite controllers" are hospitalized more often than persons with medically controlled HIV. Journal of Infectious Diseases, early online publication. doi: 10.1093/infdis/jiu809. 2014.

Karris MY and Haubrich RH. Antiretroviral therapy in the elite controller, justified or premature? Journal of Infectious Diseases, early online publication. doi: 10.1093/infdis/jiu812. 2014.

Cockerham LR and Hatano H. Elite control of HIV: is this the right model for a functional cure? Trends in Microbiology, early online publication. doi: http://dx.doi.org/10.1016/j.tim.2014.11.003.2014.

https://www.poz.com/article/life-expectancy-24972-2090 (With treatment)
Life Expectancy for Young People With HIV Is Nearly Normal

Starting HIV treatment soon after diagnosis may reduce the risk of developing HIV-related cancer by 74%
http://www.thebody.com/content/79258/starting-hiv-treatment-early-reduces-hiv-related-c.html

Starting HIV treatment soon after diagnosis may reduce the risk of developing HIV-related cancer by 74%, according to a recent study. However, starting treatment does not seem to lower the risk of developing cancer unrelated to HIV, the study finds. The data remained unclear on whether having an undetectable viral load helped reduce the risk of HIV-related cancers.

Researchers for the study, which was published Clinical Infectious Diseases, looked at data from the landmark START study, which was stopped early in 2015 because it found overwhelming evidence for the benefits of starting HIV treatment immediately versus waiting until CD4 counts drop.

https://www.poz.com/article/modern-progress-hiv-treatment-care-likely-adds-decade-life

the average age of death for a 20-year-old starting ARVs with a CD4 count greater than 350 during 2008 to 2010 was 78 years. This latter estimate is excellent news considering the recent push to get people with HIV on treatment as soon as possible after diagnosis, preferably with a CD4 count higher than 500.

The researchers believe that the continued improvement in survival during the first three years after individuals start ARVs has likely been driven by lower toxicities in modern treatments, improved adherence to treatment regimens, efforts to prevent other health conditions among people with HIV and better management of other health conditions that do arise.

July 10, 2017 - Even a Viral Load of 400 Six Months Into HIV Treatment Linked to a Higher Death Risk https://www.poz.com/article/even-viral-load-400-six-months-hiv-treatment-linked-higher-death-risk

A recent study found that those who achieved rapid viral suppression after starting antiretrovirals had a much lower long-term death risk.

People who do not promptly achieve viral suppression after starting antiretroviral (ARV) treatment for HIV are at a significantly higher long-term risk of death, aidsmap reports.

https://www.poz.com/article/primary-predictor-immune-recovery-cd4-count-start-hiv-treatment
Primary Predictor of Immune Recovery Is CD4 Count at Start of HIV Treatment
Starting treatment within four months of infection also predicted a better resurgence of CD4 cells

2018
https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciy362/4984654?redirectedFrom=fulltext

Neurological consequences of exposure to HIV without antiretroviral therapy

Conclusion
Subcortical atrophy and cortical thinning occur during untreated infection but may be arrested by cART. These findings emphasize the importance of early cART.


https://www.poz.com/article/hiv-quickly-starts-damaging-brain-treatment-halts-progression
HIV Quickly Starts Damaging the Brain, but Treatment Halts Progression
This finding adds yet more weight to the imperative of treating HIV as soon as possible after infection.

2017
https://www.poz.com/article/hiv-treatment-may-slow-brain-aging
HIV Treatment May Slow Brain Aging

2017
https://www.poz.com/article/treating-hiv-early-may-stop-viruss-damage-brain
Treating HIV Early May Stop the Virus’s Damage to the Brain

2018
Starting HIV Treatment With Higher CD4s Tied to Better Immune Rebound
https://www.poz.com/article/starting-hiv-treatment-higher-cd4s-tied-better-immune-rebound

2019
Starting HIV Treatment Very Early Offers Strong Benefits

A new analysis of the global START trial found that health outcomes were better for those starting treatment within six months.
https://www.poz.com/article/starting-hiv-treatment-early-offers-strong-benefits

2024:
“[T]he sooner ART is started after primary HIV infection diagnosis, the greater the chance of immune recovery”
https://www.poz.com/article/starting-hiv-treatment-early-leads-better-immune-recovery

2024: Early HIV Treatment Shrinks Viral Reservoir
https://forums.poz.com/index.php?topic=77920.0
https://www.poz.com/article/early-treatment-shrinks-hiv-viral-reservoir

2024: Causes of Death for People With HIV
https://forums.poz.com/index.php?topic=77680.msg




« Last Edit: January 01, 2025, 06:09:21 am by Jim Allen »
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Offline Jim

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Re: Balancing health and medication options.
« Reply #3 on: December 31, 2024, 08:52:29 pm »
Quote
I’d love to hear about others experiences.

No, you don't and what you are doing here isn't innocently asking questions either. This isn't a genuine concern or issue you have, you are trolling next to other issues and I already had enough of you on the last thread and you have not changed (See below)

I gave you a lot of room at first, just correcting you even when you posted about fake cure stories and misinformation but it has gotten worse I did give you a chance to change but you continue posting your poorly founded ideas as facts without providing any peer-reviewed references, the reason you don't provide peer-reviewed references is your statements are of course nonsense, taken wildly out of context to create a narrative or simply outdated, you are perfectly aware of this and are posting for another agenda and ill say it again this thread isn't genuine.

I wish I could help you but I can't let this continue as someone will end up reading your rubbish, not seeing it for what it is and getting seriously hurt by you. You are permanently banned.




Full thread:
https://forums.poz.com/index.php?topic=77019.msg


Quote
The largest proportion of mental problems result from the excessive use of drugs and other illegal substances

There is no denying that substance abuse can be a factor in some cases and conditions and is far more common in certain conditions. Still, mental health covers a lot of disorders, and substance abuse is far from the leading cause or factor in overall mental health disorders. Also, with substance abuse and some mental health disorders, the abuse isn't the cause but self-medication that ultimately can worsen things.

However, your statements are toxic; you are the one making these statements, so don't bother to come back until you either are either ready to apologize sincerely or have several peer-reviewed publications to present here to prove your claims that the "largest" proportion of mental health challenges/disorders are as claimed the result of drug usage.

I have given you a 7-day ban to provide you with time, and prehaps you will learn something if you actually do read up.


Below is a short list of some conditions the 970 million people living with a mental disorder have, so I expect a lot covered if you choose to return and not apologize and instead offer peer-reviewed publications proving the " largest proportion are stemming from "excessive use of drugs and other illegal substances" as is your claim.

Attention deficit hyperactivity disorder (ADHD).
Behavioural and emotional disorders in Children
Bipolar affective disorder
Schizophrenia
Depression
Dissociation and dissociative disorders
Eating disorders
Obsessive-compulsive disorder  (OCD)
Paranoia
Post-traumatic stress disorder & post-traumatic stress injury (PTS)/(PTSI
Psychosis
Anxiety disorders
specific phobias (for example, agoraphobia and claustrophobia)
panic disorders
oppositional defiant disorder (ODD)
conduct disorder (CD)

(PS. If I got the naming incorrect on any of these disorders, I apologize; I don't keep up with all the name changes)

« Last Edit: January 01, 2025, 06:00:33 am by Jim Allen »
HIV 101 - Everything you need to know
HIV 101
Read more about Testing here:
HIV Testing
Read about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read about HIV prevention here:
HIV prevention
Read about PEP and PrEP here
PEP and PrEP

 


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