To start meds or not to start meds ... that is the question

[SecretKeeper]

 

Sorry - I had typed a long drawn out explanation of my situation last night and I'm not sure where it went so I will add it now.  (I guess I should've paid better attention before I posted.)  Anyway, here it is again ...

I believe I was infected 6/09/07.
I tested negative 6/21/07. 
I re-tested out of concern in August and received a positive result 9/10.  (The result was confirmed by Western Blot but not by means of blood.) 
On Thursday (9/13) I had my first blood draw and will receive those results 10/05. 

At the blood draw the nurse mentioned several times that the doctor will probably want me to start meds right away since it's so early into it.  I know meds are a big step and I'm hoping to make an informed decision before starting anything (especially because I feel that this Virology clinic is not always looking out for our best interest, but they are our only option for now.)  And even if I don't start meds that day I'm hoping by making this post I will at least have some good informed questions that I may want to ask.

Anyway, I am really just looking for any information that you can provide on the risks/benefits/etc. of starting meds right away.  Also, was wondering if I am to start on meds what would be good for someone in my situation.

(I do want to add that I really don't want to go on meds, but if it is best for me I will and I know I can adhere to the program, but I just don't want to if it doesn't benefit me one way or the other.  And even though I can adhere to a regimen, it will be a huge pain in my rear - I have 2 very young children, 2 Great Danes, 3 cats, a job, a mortgage and a husband who is also HIV+.)

[LPinUK]

I think a little bit more information is required to answer your question.

[xyahka]

I think you still don't get your first numbers back, but well... until that happen and talking about an hypotetical scenerio i would say i agree with Ann, i personally consider one should not start meds right away... but only when they are needed.

Not only because of the side effects of them but actually because of the effort needed to stick to the treatment, plus the risk of developing resistance.

Here in Ecuador for exemple, as soon as you are around 200 they want to get you in meds immediatly... but one should be really sure if there is a trend to go low... for that you might need more than one labwork. I have met people whom their first CD4 is 201 and their second is 225. So sometimes there is a chance to improve numbers.

There are not too many meds available to fight this... one should keep them for the moment when they are needed, none wants to get rid of bullets before time... just my point of view.

Cheers,

Juan Carlos

[Queen Tokelove]

Wondering where Ann posted at? I know I am buzzed but damn. Back to the topic at hand, I would say wait til you get your results. I am wondering why the nurse said this knowing you didn't have the results. She may have been trying to prepare you for the worst, not sure. Bottom line is the choice will be yours regardless of what doctor says. Let us know how it goes....

[Tempeboy]

Wait, wait, wait.

Not only should you wait for your first set of results, but if you are seroconverting it will take time for your results to settle and accurately reflect your numbers. 

Most people don't need to think about meds for years.

You could ask this nurse if she/he gets a bonus from any drug companies!!!!

take it easy babe.

[newt]

You have, almost certainly, an acute/new HIV infection.

There is some evidence to suggest that a short course of antiretrovirals now will help your body adjust to dealing with the virus, in particular produce a lower viral "set point" (level of ongoing HIV replication which your body maintains by controlling it with the immune system). A lower set point may, it seems, be better long term.

But...

This is strictly speaking unproven and theoretical.  There is not yet a trial that has reported which confirms/refutes the long-term benefits of treatment during acute infection. There is of course the risk/benefit question to weight of meds now causing (perhaps) side effects etc v (possible) advantage in the long-term. And you may not be in a frame of mind to go on meds just now.  It is important to have your head sorted, because, even though this is gonna be a short (3 months, 6 months perhaps a year) course, it still requires commitment.

This is a good article summarising current research an thinking - Does Early Treatment of Primary HIV Infection Delay Treatment Indication? (The Body). Concludes:

"It appears sensible to make HAART available to individuals with early HIV infection, if such individuals (in consultation with their health care providers) feel this is the most appropriate course of action to take."

This article is sober, balanced overview - Treatment during primary infection (Aidsmap).  Key point is in the first few paras:

"Controlled studies have shown that intervention with a range of different drug combinations during primary infection results in significantly lower viral load and significantly less viral infection of lymphoid tissue. However, at the moment we have no idea whether adjusting the viral load at this point in HIV infection affects long-term prognosis, although early treatment does reverse CD4 cell count decline."

In short, we know what combo in early infection does to the virus (results in less) and immune system (higher counts) but we do not know if this translates into a long-term benefit.  The theory that it will do so is plausible and well thought out.

Hope this helps.

- matt

[BT65]

It's a personal choice and I personally wouldn't do it if I was newly infected.  You need to wait and see what several bloodwork results show.  Just take it easy. 

[milker]

I urge you to read the Lesson about treatment before you make a decision.

Milker.