When to start ART

[zimba]

Diagnosed positive in 2015 and not on ART since then. The most recent virus load check says it decreased from 11 000 to 3000. What should I do, should I just let my immunity itself to deal with the virus or should I start ART? CD4 count unknown because the accounting machine out of order.

[Jim Allen]

Your immunity, you have it so your not immune to it and your immune system is not dealing with it ...

Sorry to tell you but your dropping VL well VL will drop to a viral rest point this is different for reach person and it than increases again during the infection and progress of the illness and we know now the counts only tell part of the story and health outcome.

When to start ART ....

One thing stands out is that nowadays it is the general recommendation that all HIV+ people should be on treatment.  No matter what the counts as they only tell part of the story and health outcome.

it's has been shown that outcomes are just far better when starting meds sooner "if possible" and that's why it's not recommended not to wait and that anyone infected with HIV should begin antiretroviral treatment as soon after diagnosis as possible.

In the past treatment was often delayed based on the counts but we now know is that Immune system damage and certain HIV-related health problems can occur at even with good counts.   Below I have provided some links.

Look end of the day only you can decide what to do its your life, however treatment to prevent further immune damage and early illness followed by dying is generally the recommend course of action.

I recommend you speak to your doctor to find out what the policy is on when to start treatment where you are living.

Jim

WHO - Treat all recommendations
http://www.who.int/mediacentre/news/releases/2015/hiv-treat-all-recommendation/en/

Starting treatment
https://www.poz.com/basics/hiv-basics/starting-hiv-treatment

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

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

[Jim Allen]

We also had a sticky on the topic, its locked now as its not relevant. Outcome was simply to start treatment sooner... http://forums.poz.com/index.php?topic=51849.msg705055#new

[zimba]

If my immune system is not dealing with it then what the virus load decrease is due to?

[Jim Allen]

Its called a viral set point.

If you had immunity you would not be infected in the first place and if your immune system could "deal with it" you would be a worlds first to do so (Berlin patient had help)

Your HIV infection is not going to go away and it is normal for the VL to drop after the initial stages and than to slowly increase over time.

Did you read any of the links or just post straight back? (Don't answer)

Even for people who can control the VL themselves at UD levels it is recommended to start treatment as soon as possible as the outcomes are better. The count and VL is not the full picture of the damage being done from untreated HIV.

Look read the the links, gain some insights and talk to your doctor to decide what you are going to do. Its up to you.

Jim

[zimba]

"it is normal for the VL to drop after the initial stages and than to slowly increase over time. "
sorry maybe I am dumb but yet I cannot understand how and where the difference of 8000 virus particles per ml3 disappeared? did they hide into the so called reservoirs or the immunity itself fought them off?

[Jim Allen]

Hi

The set point is after the system put in some initial resistance, you body produces Cytotoxic T cells and tries to fight,  Difference is that initial resistance does not last.  The HIV levels stabilizes after a period this is the set point.

Now as said if even if you were a elite controller as example and nothing indicates that yet than its still recommended to be treated as you will still be infected with HIV and it will still be causing damage to you.

Have a read of the recommendations, take it in and talk to your doctor. Decide with the information and a talk with your doctor what you are going to do for yourself.

Jim

[Ptrk3]

Jim gave you the essentials.  It is my understanding that after the initial infection,  HIV viral load spikes during "seroconversion," regardless of whether symptoms are experienced, then is significantly reduced as the infection is battled by the immune system (primarily the CD4 cells), but eventually, and it may take anywhere from several years to a decade or more, before the viral load spikes again (the CD4's become exhausted, die, are taken over by the HIV) and the opportunistic infections associated with AIDS or advanced HIV disease become manifest and the patient sickens and, ultimately, dies.

Not sure the ratio of HIV that forms the reservoirs and the HIV that remains in circulating blood, but the HIV replicates in both.

In short, you need to begin treatment as soon as practicable before you suffer permanent damage to the immune system, organs, or nerves (develop neuropathy, etc.):

http://www.webmd.com/brain/understanding-peripheral-neuropathy-basics#1

[CaveyUK]

Even people who can 'control' HIV well can have other health issues due to the virus (some reports, suggest even more health issues than those who don't control it well), so the recommendation is to start treatment ASAP.

The side benefits of starting treatment include becoming UD which will prevent the virus being passed on, and the psychological benefit of knowing you are taking control.

Years ago, the meds were difficult to take. That isn't the case nowadays, so unless you are prevented from starting due to the country you live in, you should absolutely look to get on treatment.

[zimba]

How cd4 cells could suddenly become exhausted since the virus retreated in the so called reservoirs?

During HIV infection, CD8+ T-cells are able to recognize infected cells but the high mutation rate of HIV has allowed the virus to escape CD8+ T-cell recognition. So, the key issue here is the high mutation rate of HIV, not the reservoirs - in my opinion. AZT does penetrate the brain tissue and destroys RNA of HIV, for example.

My viral load decreased from 11 000 per ml3 to 3000 and the references tell us that there is no possibility for health issues if the viral load does not exceed 100 000 per ml3. http://www.aidsmap.com/Viral-load/page/1254932/

[zimba]

Treatment guidelines recommend that anyone with a viral load greater than 100,000 copies/mL of blood should begin treatment.
Viral load is used to predict how long an individual will remain healthy, or how quickly the disease will progress. A viral load greater than 100,000 copies/mL of blood within six months of seroconversion indicates a greater likelihood of developing AIDS within five years. A viral load less than 10,000 copies/mL of blood in the early stages indicates a decreased risk of developing AIDS.

[Wade]

You have HIV and it is not going away by itself...take your damn pill and be done with it. There have been several on this board over the years who waited to start treatment and regret it.

Wade

[zimba]

They regret it because they left the viral load unchecked; I visit my doctor every three months. The references are clear: THERE IS NO HEALTH ISSUE FOR VIRAL LOAD THAT COUNTS LESS THAN 100,000 ML3

[Wade]

What ever...I would still rather be UD than have virus in my blood, but thats just me.

[zimba]

You are not yet UD because for example even if the virus is cleansed from your tissues and peripheral blood still the test will detect antibodies, in our case when there is no vaccine, the virus still does replicate in the tissues or the so called reservoirs that causes the so called "persistent inflammation" which is related to Non-AIDS issues such as the cardiovascular deceases are.

[Jim Allen]

Hi

AZT does penetrate the brain tissue and destroys RNA of HIV, for example.

Is that the treatment option available to you? Zidovudine (AZT, Retrovir)

But yes its does penetrate the blood barrier to the brain, there are more modern meds that are better at it, Zidovudine words by blocking an HIV enzyme called reverse transcriptase, it does not cure however just to be clear there is no cure.

https://www.poz.com/drugs/classes/Nucleoside-Nucleotide-Reverse-Transcriptase-Inhibitors

My viral load decreased from 11 000 per ml3 to 3000 and the references tell us that there is no possibility for health issues if the viral load does not exceed 100 000 per ml3. http://www.aidsmap.com/Viral-load/page/1254932/

Today, viral load isn't recommended or used to figure out when therapy should be started.  There simply is clear-cut proof that of the significantly greater health benefit to an person living with HIV starting antiretroviral therapy sooner rather than later.

I don't see any such reference in the link you provided to that 2013 VL guide that a low detectable VL is no possibility issue for your health, the contrary has been shown and published hence experts recommend to start treatment and not to wait.

Overall it's better to start meds sooner "if possible" and that's why it's now recommended not to wait anymore and that anyone infected with HIV should begin antiretroviral treatment as soon after diagnosis as possible.

I don't see how you got that conclusion that your detectable VL is not doing any harm, this is simply incorrect and a dangerous outdated line of thinking.
Long term outcomes are better starting treatment sooner and helps prevents  illnesses that can occur at any stage of the illness irrespective of counts.

In the past treatment was often delayed based on the counts but we now know is that Immune system damage and certain HIV-related health problems can occur at even with good counts and low VL.  Hence if possible do at least start looking into, working with your doctors and thinking about what treatment options are available to you.

How cd4 cells could suddenly become exhausted since the virus retreated in the so called reservoirs?

Who said it was sudden? How slow depends on each person and strain of hiv etc.  however it does progress.

At first your VL will be high and your CD4's will drop, the virus will reach a set point and your  VL will drop by this time the setting up infections in so called reservoir locations has already happened, your CD4's count will recovery somewhat not fully. Than during what used to be called the asymptomatic stage, the virus continues to reproduce at very low levels, although it is still active and slowly eventually your viral load will begin to rise and your CD4 count will begin to decline.

Again using VL & CD4 counts to decide the start of treatment is no longer recommended as far more is known and understood. Illness can happen at any stage or count however it is less likely with a suppressed VL and even less so when you are on treatment.

Anyhow, whatever you decide is up to you, all I can do is give you the correct info and recommend you work with your doctors, however fool yourself not us, your HIV infection is causing you harm untreated.

Jim

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

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.


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

Starting treatment
https://www.poz.com/basics/hiv-basics/starting-hiv-treatment

[Jim Allen]

They regret it because they left the viral load unchecked; I visit my doctor every three months. The references are clear: THERE IS NO HEALTH ISSUE FOR VIRAL LOAD THAT COUNTS LESS THAN 100,000 ML3

Bullshit

Now you have the info, if you start treatment or not is up to you I will not loose any sleep over it, however keep the crap to a minimum. You have been warned before today as well to cut it out.

You are not yet UD because for example even if the virus is cleansed from your tissues and peripheral blood still the test will detect antibodies, in our case when there is no vaccine, the virus still does replicate in the tissues or the so called reservoirs that causes the so called "persistent inflammation" which is related to Non-AIDS issues such as the cardiovascular deceases are.

Stop it, UD is having an undetectable viral load in your blood stream, so below 50 copies m/l that's what it means. Wade did not suggest anything other than that.

You have been banned once before for your shit and warned this time as well twice already, your flaming a topic and fake threads / posts to flame bait will not work. Eat all the foot cream you like as far as i am concerned don't expect any room here however to run amok.   

Treatment guidelines recommend that anyone with a viral load greater than 100,000 copies/mL of blood should begin treatment.
Viral load is used to predict how long an individual will remain healthy, or how quickly the disease will progress. A viral load greater than 100,000 copies/mL of blood within six months of seroconversion indicates a greater likelihood of developing AIDS within five years. A viral load less than 10,000 copies/mL of blood in the early stages indicates a decreased risk of developing AIDS.

Bullshit, what outdated rubbish are you on about?
Enough now, you have pushed my patience to far again.

Jim

[Jim Allen]

You banned once again, I allowed the account I thought you might have woken up to the truth but you have not.

See one of your past thread, its the same again:
http://forums.poz.com/index.php?topic=63696.msg710092#msg710092

This is simple, there is no conspiracy, there is no hidden cure, your meds are not evil or some sort of government plot and if you don't treat your HIV it will fucking kill you in the most evil and twisted, fucked up ways. 

I wish you well, but you and your flame baiting here, twisted views, unsupported claims, denial of HIV and promoting of fake treatments have once again have lead to you being banned and this time no retry.

I am sick of cleaning up your posts and mess here.

Jim

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

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.

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

(Edit for spelling)

[DANIELtakashi]

Sad.

OP,
As l wrote before, please think of those who had no choice but die before the medication, Elizabeth Glaser and her daughter Ariel.  My friend who worked with me in Tokyo in the 1990s.
With no medication, he returned to the USA to die.   I helped him clear out his place and said goodbye to him for good.

[harleymc]

Time to lock the thread, there's too much half-baked, half understood, only half truthiness rubbish coming from the OP.

This issue has been decided conclusively by medical science. Start ART as soon as practical. The state of the art is same day prescribing and dispensing, but we all don't live in a perfect world, so as soon as practical it is.

[Mightysure]

I wish there was a way to scrub old information based off of little to not research or old treatment regimes. Those and outlier studies breed these conspiracy theories that shorten and end lives of people who were savable.
Your viral load matters, the more you let it replicate uncontrolled, the more damage you do to your immune system, the larger your reservoir grows and the harder it is for you to recover once you start treatment.
A drop in viral load doesn't mean your immune system isn't taking a hit or that it's necessarily "handling" the virus.  VL aren't exactly linear for people not on ART.
THE drugs put now aren't like AzT and the earlier drugs. There aren't any long term side effects for most people.  It's sad that with all of the progress science had made,  that people still want to live in the past.
If anyone doesn't believe in evolution, here's a case of natural selection and survival of the fittest at work.

[Jim Allen]

I wish there was a way to scrub old information based off of little to not research or old treatment regimes.

Worst often is its often official or government sites hording old treatment or theories since replaced with newer understandings or updated treatments, its not just the paranoid tin hat man.

That said can't control it and personally I do believe people will always see what they want to see, or find what they asked for. Just like the guy eating the tropical foot-cream because it contain an element from some limited Petrie dish study 
If we removed the old stuff someone will cry foul and claim cover up as well. Damned if you do damned if you don't.

Also more than 1 way to read information and search for it, very simplistic example. Online search engines are used to find often this outdated rubbish but problem is online searches tells reflects the mood/way you asked the questions, its what you looked for not want you need.

Question:
are apples good for you

• 15 Health Benefits of Apples | Best Health Magazine Canada
• 5 Health Benefits of an Apple - EatingWell
• Apples: Health Benefits, Facts, Research - Medical News Today

Question:
are apples bad for you

• Are apples still good for you? | Daily Mail Online
• Healthy foods that are apparently bad for you - Telegraph
• Is Fruit Good or Bad For Your Health? The Sweet Truth

The 1 thing i can and have done is lock this thread - https://forums.poz.com/index.php?topic=51849.0 with updated information that mods done the line can than update when needed with new information. (the thread gets a lot of views)

Anyhow I will lock this one as well left it open for a few days but its reached  its end.  I know not popular but think its best.

Jim