Am I in great danger?

[canadiandesperate]

Hi,

I was infected almost 4 years ago. Last year my viral load was 572 331, this year (1 week ago) 758 165.
My CD4 last year 634 (21%) and this year (1 week ago)  369 (15%).
No meds and I'm affraid to enter in the system in Canada for many professional and personnal reason. So I get tested in Bangkok where I was travelling for my work. I'm I in danger here? Do have I to start meds now? If not, how many time I got left? Maybe I will loose my job (and all I care about) if i'm going in the system with some country I will not able to enter anymore (essential to my job) because of my status.

Thank you!
A very affraid man...

[Matty the Damned]

Hi,

I was infected almost 4 years ago. Last year my viral load was 572 331, this year (1 week ago) 758 165.
My CD4 last year 634 (21%) and this year (1 week ago)  369 (15%).
No meds and I'm affraid to enter in the system in Canada for many professional and personnal reason. So I get tested in Bangkok where I was travelling for my work. I'm I in danger here? Do have I to start meds now? If not, how many time I got left? Maybe I will loose my job (and all I care about) if i'm going in the system with some country I will not able to enter anymore (essential to my job) because of my status.

Thank you!
A very affraid man...

No doubt a conga line of Canadians will point out that Canada has strong Anti discrimination policies regarding HIV, so I'll leave the bush-lawyering to them.

Are you in danger with those numbers?

Frankly yes. 21% is pretty much the border line where you need to consider starting medications. 15% is considerably below that.

You're in danger territory son.

Now, you might like your job but It's gonna be hard to do it if you're laid up in hospital with PCP. Would I seek treatment in Thailand or Canada?

That question is a bit like asking "Would I get open heart surgery from a cardio-thoracic surgeon or a vet?"

Your options are pretty straight forward. Start medications and live. Continue to prevaricate and die.

Also, welcome to the Forums.

MtD

[le_liseur]

Canadiandesperate,

I hardly see why you would be afraid to "enter the system", especially if you're borderline with these numbers. You would have been best to test more than once a year, too...

Do you have private insurances with your work? Or are you on a public plan? Or have you been avoiding to pay any health insurance for some reasons? If you're on a private plan with a company that needs you to travel to Thailand for work, I'm pretty sure you will not bring your employer to bankruptcy, and if you're on a public plan, your employer will never know about this...

 In which province do you reside?

[canadiandesperate]

Thanks to you both!
I live in Quebec but out of the country for another 2 months...
I'm on public care. I think it's like 800$ ayear for meds. Not a problem.
But now I'm a little bit nervous about the next 2 months...I hardly can go back before...Going to Indonesia next week for 6 weeks and come back to Canada.

I test only when I'm in Thailand to do some anonymous test of viral and CD4.
I don't think Thailand is bad for HIV care. The clinic I go for testing it's beside the Thai red cross AIDS research centrer.

So do I wait to come back to Canada? I don't even know if I'm going to be able to enter in Indonesia with the meds and so the status...

Thank you

[canadiandesperate]

I'm still in Thailand right now. 

[Matty the Damned]

I'm still in Thailand right now. 

With your numbers I'd be getting medical attention wherever I could find it. Thailand, Indonesia -- wherever.

But  you will have to make decisions fairly soon. Decisions which will extend beyond the comfy perview of your employment.

And seriously, if Canada is an option then you should take it.

Of course this is just my opinion. I've never set foot in Canada, Indonesia or Thailand.

MtD

[Assurbanipal]

There is no need to panic. 

Most countries now tell people they should start meds when the tcell count goes below 500, but only a few years back the generally accepted level was 350.  Starting earlier helps preserve your immune system, but you are not in desperate straits should you need to wait a month or two until you get back to Canada.

It is important for your long term health that you start meds relatively soon, though, and do so in a considered manner with a commitment to staying on the meds and taking your pills each day.  You might start practicing with a vitamin whilst you are still in Thailand.

For you, staying healthy with HIV is still a long-term proposition -- you need to get onto meds and stick with them starting fairly soon.  If you delay, it may become a short-term proposition as well -- not the desirable course at all.

Best
A

[Matty the Damned]

And indeed nobody has advocated that this new member panic. But there is certainly cause for concern in the numbers he has provided us with.

He needs to give careful consideration to his options. I'm sure that adequate services are provided in Thailand or Indonesia to those who can pay for them.

I'm nearly equally as sure that the services in Canada at least equal those available in Thailand. Sure you may not have the pleasure of chickens running around the waiting room in Vancouver but at least the public health will foot the bill.

MtD

[buginme2]

A cd4 percentage of 13% or lower puts a person at risk of aquiring PCP regardless of what their absolute cd4 count number is...the op's cd4% is 15%.  He IS very close to needing to panic.

Source: http://www.aidsmeds.com/articles/TCellTest_4727.shtml

Its just me but if I'm gonna get PCP I would much rather get it in Canada then Thailand or Indonesia.  That must be one hell of a job you got to be risking it all for.

[puuchai]

Hi canadiandesperate, I live in Thailand and know of the place you go for checks,It is often when your cd4  is below 200 that they start you on meds here,having said that if you where to see a private hiv doc you would probably get put on meds.There are many of the western world meds available here if your paying for them,but if you start on meds here then your gonna have to follow through on the same meds in Canada one would think,also meds here are prescription only and most doctors dont give more than a one month supply at least until they establish that your doing ok on them.Another thing is that unless you request it,doctors wont normally do a resistance test here.No problems with chickens running round the clinics though lol.Like others have said,your gonna have to jump on the band wagon soon or you wont be fit to do a job anymore.There are some great hiv docs here by the way and i can point you in the right direction should you decide to get things rolling here,best wishes..

[Ann]

Hi Canadian, welcome to the forums.

I agree with those who are saying that you need to start treatment, the sooner, the better. Not only do you have low CD4s, but your CD4% is also VERY low. Equally concerning is your VERY high VL. It's way too high and your CD4s are going to continue to decline as long as your high VL goes unchecked.

As most here know, I'm an advocate of waiting until your numbers indicate the need for treatment, and buddy, your numbers are absolutely screaming out for treatment.

Stop worrying so much about your job and start worrying about your life. No life = no job. There's no way around it.

Good luck and keep us posted.

Ann

[newt]

The nub of this seems that you need to get your head round being a Canadian with HIV. Having to tell eg yer boss, family, friends everything when you are hospitalised with PCP et al is no hot date to look forward to. Agree with what Ann, MattdeD etc said about your CD4% and need for treatment. This is not an ostrich moment.

Sorry to be blunt, good luck and safe travels.

- matt

Edited for spelling

[Theyer]

Welcome Canadian ,

I agree with the consensus here that you are risking illness with your numbers and the level off stress from the fear must be both horrible to live with and not helping with your overall health.

I confess to being curious as to the details off your fear and would urge you to find a trust worthy source to really test them out as Matty said Canada is not known for its discrimination. You could use here or seek another  source that will give sound advice based on Law.


Newts point that with illness explanation will be necessary, is clear thinking,and from my own experience fear puts paid to clear thinking.

I hope this is helpful and that you Quickly reduce the burdon off fear and worry you have,
take care off yourself
Theyer

[emeraldize]

Bangkok's got some incredible medical care available. Lots of people go there from other countries because of their level of care (for cancer, surgeries, etc. ) In many of their facilities, the nurses wear crisp white uniforms complete with caps! And, in certain places there is tea and cookies available in the waiting room. Further, they are respectful about time and their pace can be somewhat Germanic.  Quite impressive.

How soon are you due back in Canada? If it's not for a while, I'd consider starting care in Thailand. However, given that it seems you spend more time in CA than on the road, were I you, I'd rather get established with someone who's going to be in for the haul to get me squared away.

[littleprince]

Two things:

1. Opportunistic infections suck. I had PCP and spent 4 days in intensive care, a month in hospital and a total of 3 months off work. It took me 12 months to feel 'normal' again and not have to sleep during the day. It happens fast. I went from fine to tired to intensive care in 2 weeks. I'd only stay in Thailand if you can afford to do some serious hospital / recovery time there.

2. Starting meds isn't always smooth. I'd plan to be around a doctor for at least the first month or 2. Most people start and don't have any problems but there are some things that could require a change of meds or doctor input.

[Inchlingblue]

Aren't there privacy laws in Canada? Does getting treatment mean your boss will find out? I find that hard to believe.

[buginme2]

Aren't there privacy laws in Canada? Does getting treatment mean your boss will find out? I find that hard to believe.

Yes there are, PIPPA and PHIPA acts guarantee privacy in Canada.

[canadiandesperate]

First, sorry for my English, sometimes I’m not sure about the word and verb...

I want to start my message by thanking you all! Thank to you people who don’t really know other people here and take your time to read and answer messages and trying to help people. At first, when I learn about my status, I was so desperate and alone. No one to talk about my situation. It’s people from forum like this one who give me the strength to continue. So thank you all.

Last night, I went for dinner in a very nice rooftop lounge restaurant with the only friend I have here in Bangkok. We eat good food, talk, have fun and drink a lot of wine. I know it wasn’t the best idea with my fragile health to drink a lot of wine but it make me feel good and forget for a moment. After I leave him, I grab a cab and go to one of the only gogo bar girls I’ve been here to see that beautiful, sweet and very smiling girl I saw at that time. I ask (and pay) her to come back to my hotel with me. We didn’t have sex, really didn’t want to with my mood...just cuddling. So the plan was just to sleep beside someone because I feel so alone at this moment. When I wake up this morning, back to reality, I said to myself: I want to have more dinner like yesterday with friends, I want to live! So today, I wrote an email to the person I saw at first last year here in Thailand to ask about what he think about my result (because when they send it to you by mail they don’t comment). He answers me to come without appointment to meet him and he was worried too about my result, especially about the 50% drop of CD4 from last year. So tomorrow I will go there to see him...and I will come back to you on that. If he want me to start me right now on meds (and if I agree) or wait until comeback to Canada, do you have any suggestion of meds for me? I don’t know a lot about the meds...Is there a meds who have less side effect and still efficiency. I can live with side effect that other people cannot see (like headache and nausea) but what afraid me is drastic change in my body, face and stuff like that.

What afraid me about my job it’s about the travelling part of my job. I’m afraid to lose my job only if I cannot travel to some country I will not be useful for my company anymore and will have to tell them why I cannot enter in a country... I don’t know about now with Obama but I remember when Bush was there, we cannot enter in the country if we were HIV +. Don’t know about now, don’t know about other country...If I lose my job because of that, I will not engage a legal fight with my company because I don’t want to become public with my status...another reason why I have to take meds and stay away from PCP and shit like that (so agree with newt (Matt)).

Last year, I know I was at the limit but I take a cocktail everyday of all the good natural product was supposed to be good for viral load and CD4 and other stuff (Selenium, curcuma + bromelain, deglycyrrhizinated licorice root extract, vitamin C, garlic) and hope to give me enough time to see a miracle in a cure. But seems like time not playing for me (maybe it make stay away from some disease because I didn’t get sick in the last 2 years)...either the big lucrative market of the powerful and greedy pharmaceutical company wasn’t on my (our) side...so I think I don’t have choice anymore now.

Thanks to you all one more time! You are kind of hero for me and a reel example of courage for what you’ve been thru and to be here and share!

I come back to you soon. Take care all!

P.S. No there is no chickens running everywhere in the waiting room! lol People here are the most kindly person I’ve met in my life and I’m sure they are very qualify too. Canadian health care system is a reel mess and have to wait forever for care (maybe not in the case of HIV but for sure I don’t want to be treated for PCP there).

[Assurbanipal]

It is good to hear that you are resolved to live. 

As far as what drugs to start on, you might find the lessons on this site helpful.   They start here http://www.aidsmeds.com/articles/Introduction_4702.shtml  and talk specifically about modern combinations to start with here http://www.aidsmeds.com/articles/WhenToStart_4759.shtml  The article is based on the U.S. guidelines, but focuses on starting with drugs that are relatively easy to take and tend not to have the face and body changes that concern you.

Travel restrictions are getting to be less of an issue around the world but some still exist.  This site http://www.hivtravel.org/ lets you explore restrictions by country both for travel and for immigration (where restrictions tend to be more significant).

Be well
A

[canadiandesperate]

Thank you Assurbanipal! This will be very useful for travel and for meds when I look at my option with the doctor here tomorrow. As for the country I think it’s not that bad for me...China was a big ? but seems to be ok now.

[Ann]

Canadian, your English is just fine.

I'm so glad to hear that you got in contact with a doctor and are seeing him so quickly. That's great news! Please let us know how it goes.

[Inchlingblue]

Don't be afraid of the medications, overall they have greatly improved. There are several combos that have few if any side effects.

[SteveInToronto]

 Canadian health care system is a reel mess and have to wait forever for care (maybe not in the case of HIV but for sure I don’t want to be treated for PCP there).

I'm not really sure why you wouldn't want to receive your HIV care in Canada. Our system can't honestly be described as a "mess". Yes, there are some wait times for elective procedures, but overall, the health care that I have received has been nothing short of amazing. Long visits with my doctors, endless diagnostic tests to make sure my health is okay, lots of monitoring and follow up, excellent access to meds (including full coverage for low income folks as part of our social safety net)... all in all, the care is universal and outstanding. I think your fretting about the level of care in Canada is totally unwarranted and a bit ridiculous.

As for your concerns about anyone finding out your status, those concerns are also unwarranted. We have iron clad privacy laws in Canada that protect your medical information. Your employer won't know anything unless you choose to tell them. Your insurance company won't tell your employer anything about your claims you make, and neither will your medical team. In addition to federal privacy laws, each province also has legislation to protect individuals' privacy. Medical information is one of the most sacred types of information that privacy laws protect.

It's great that you are moving forward with your treatment in Thailand, but remember that the standard of care in Canada is excellent, and you really don't have to worry about it.

Steve

[buginme2]

Bangkok's got some incredible medical care available. In many of their facilities, the nurses wear crisp white uniforms complete with caps! And, in certain places there is tea and cookies available in the waiting rooms.  Quite impressive.

Sorry Steve as much as you tout your "social safety net" and iron clad privacy laws, it just simply cannot compare to Thailands crisp white uniforms and excellent use of tea and cookies.  Canada should really learn its place. 

[canadiandesperate]

Thank you Steve but of what I see, you are from Toronto maybe we are both Canadian but I’m not sure it's the same in both provinces. When I had my primary infection (was really sick) and didn't think about having HIV at all at that time (just having one girl sex partner after been annually test because of multiple partners), I spend 20 hours waiting (15 waiting in the waiting room and 5 in a bed in the hallway finally because I was sweating, nausea...in the waiting room) lots of test later, they didn't find what I've got, they want to do more test in 3-4 hours, have to wait for the biologist or someone else, I finally ask to leave to get in my bed and wait for the day after because not only I hate hospital but being reel sick in a hallway it’s nothing fun. I’ve got better and never get back. 3 of my good friends are nurses, one of them leave for Switzerland because she was exhausted of the 20 hours shift (like almost all nurses in Quebec). But they are one of the best nurses in the world, the problem, like for our doctor, they have a reel staff problem in quantity. I’m sure I will be fine with the HIV treatment in Quebec because you have appointment, I just don’t want to be sick there (PCP...) and neither here by the way.

About the discretion of the system, 10 years ago, the new boyfriend of my ex girlfriend who was a pharmacist, didn’t like me, taught maybe I try to comeback with her, told her that I had papillomavirus to turn her off...well he’s still a pharmacist, still don’t like me (jealous) and still an as****le! He would be please to have that kind of scoop especially now because I’m starting to be known in the community...Don’t want that at all. Not good for my job either...I think all the pharmacies are connected together. But now, I have to take care of myself and take the risk about my status going public, losing my job, facing the stigma...   

And please everyone, there is good doctor everywhere in the world so don't have too much prejudice about poor country because they have a heart, they can care and in general, they care more about people than money and some of them had very good education (some in the USA). After all, the best doctors in the world are supposed to be in Cuba (a reel poor country). The cookies thing is not essential in the health care but it show me how much Thai people are caring people. We have cookies (and all greasy food in our hospital) too in Canada but we have to pay for it!

Still, the best thing for me is to go back to Canada in the next days but I don’t have any appointment there, have to maybe wait and I’m afraid to take a 23 hours (not sleeping well or at all) flight and waiting airport beside people (and so multiple potential virus with a bad immune system)...This and have to answer some questions about my early comeback and not finishing my work...So I will see with the Thai doctor tomorrow (without the chickens running and maybe with some cookies;) what's are the best thing to do for me.

Here it's the night, so good day all and good night for me.

[SteveInToronto]

Thank you Steve but of what I see, you are from Toronto maybe we are both Canadian but I’m not sure it's the same in both provinces.

I hear what you are saying about emergency room wait times...they are pretty brutal when you have been triaged down the ladder in importance. My comments were more focussed on more "routine" care from an HIV specialist. Also, if you had a serious situation like PCP, you'd be admitted to the hospital and not waiting in a hallway in the emergency department (at least I would hope not). I take your point that hospitals are probably different in our two provinces.

Sorry Steve as much as you tout your "social safety net" and iron clad privacy laws, it just simply cannot compare to Thailands crisp white uniforms and excellent use of tea and cookies.  Canada should really learn its place. 

I think you may have something here... Our lack of crisp white uniforms is clearly unacceptable... uh...and cookies? That's a nice touch. I never get cookies at my doctor's appointments. Shame on Canada!

[mecch]

Last year, I know I was at the limit but I take a cocktail everyday of all the good natural product was supposed to be good for viral load and CD4 and other stuff (Selenium, curcuma + bromelain, deglycyrrhizinated licorice root extract, vitamin C, garlic) and hope to give me enough time to see a miracle in a cure. But seems like time not playing for me (maybe it make stay away from some disease because I didn’t get sick in the last 2 years)...either the big lucrative market of the powerful and greedy pharmaceutical company wasn’t on my (our) side...so I think I don’t have choice anymore now.

Let me get this straight.  You have been waiting for a "miracle cure".  You think the powerful and greedy PHARM industry has it in for HIV+ people and is blocking a cure?  And, you have been taking supplements thinking this could help you get to the cure date.

Listen, only 2 things determine your progression from infection to AIDS.  1) Genetics.  2) If when its your time, you take HAART, you don't get AIDS.

If I had a penny on every dollar wasted on supplements taken in the hope of fighting this virus, I'd be a multimillionaire and probably yes, a big contributor to scientific research on the AIDS CURE.

[buginme2]

And here I have been wasting all this time and money on going to the doctor and taking my medication when I could have just taken some garlic, licorice, and vitamin c (an orange?).

[Miss Philicia]

It never fails to amaze me how some folks develop these really novel approaches to dealing with a life threatening disease.

[Joe K]

Thank you Steve but of what I see, you are from Toronto maybe we are both Canadian but I’m not sure it's the same in both provinces. When I had my primary infection (was really sick) and didn't think about having HIV at all at that time (just having one girl sex partner after been annually test because of multiple partners), I spend 20 hours waiting (15 waiting in the waiting room and 5 in a bed in the hallway finally because I was sweating, nausea...in the waiting room) lots of test later, they didn't find what I've got, they want to do more test in 3-4 hours, have to wait for the biologist or someone else, I finally ask to leave to get in my bed and wait for the day after because not only I hate hospital but being reel sick in a hallway it’s nothing fun. I’ve got better and never get back. 3 of my good friends are nurses, one of them leave for Switzerland because she was exhausted of the 20 hours shift (like almost all nurses in Quebec). But they are one of the best nurses in the world, the problem, like for our doctor, they have a reel staff problem in quantity. I’m sure I will be fine with the HIV treatment in Quebec because you have appointment, I just don’t want to be sick there (PCP...) and neither here by the way.

About the discretion of the system, 10 years ago, the new boyfriend of my ex girlfriend who was a pharmacist, didn’t like me, taught maybe I try to comeback with her, told her that I had papillomavirus to turn her off...well he’s still a pharmacist, still don’t like me (jealous) and still an as****le! He would be please to have that kind of scoop especially now because I’m starting to be known in the community...Don’t want that at all. Not good for my job either...I think all the pharmacies are connected together. But now, I have to take care of myself and take the risk about my status going public, losing my job, facing the stigma...   

And please everyone, there is good doctor everywhere in the world so don't have too much prejudice about poor country because they have a heart, they can care and in general, they care more about people than money and some of them had very good education (some in the USA). After all, the best doctors in the world are supposed to be in Cuba (a reel poor country). The cookies thing is not essential in the health care but it show me how much Thai people are caring people. We have cookies (and all greasy food in our hospital) too in Canada but we have to pay for it!

Still, the best thing for me is to go back to Canada in the next days but I don’t have any appointment there, have to maybe wait and I’m afraid to take a 23 hours (not sleeping well or at all) flight and waiting airport beside people (and so multiple potential virus with a bad immune system)...This and have to answer some questions about my early comeback and not finishing my work...So I will see with the Thai doctor tomorrow (without the chickens running and maybe with some cookies;) what's are the best thing to do for me.

Here it's the night, so good day all and good night for me.

I'm curious where you get your health care in Quebec, because I live in Montreal and our system is excellent.  I've been here four years, to the ER many times and have never encountered what you describe. I get my HIV care from the specialty clinic at CHUM and yesterday, when I needed to see a doctor, without an appointment, I was there for a total of 3 hours.  During that time I got full sinus and chest x-rays, some cultures taken and 40 minutes with an HIV specialist.

If you decide to get your care in Quebec, you should find an HIV specialist connected with a hospital. To use the example of being kept waiting in the ER, when you don't know which other types of patients were there, as a criticism of the Quebec health system is horribly unfair. Most probably, you had to wait, because you were not dying and patients are taken in order of need, not arrival.  Socialized medicine includes some compromises, but I have never heard any of my friends complain about the health care they receive.

[John2038]

Hi canadiandesperate

Based on your VL (>100'000), CD4 (<500) HAART is recommended for you.
Also, some health care providers use the CD4% going below 15% as a sign to start HAART, even if the CD4 count is high.

See the U.S. Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents - January 10, 2011

Genotype assay testing is recommended at the time of entry into HIV care, regardless of whether therapy is initiated immediately or deferred. As such, this is something you may want to do now.

Understand that you will have to start HAART sooner or later (the sooner the better).
HAART are highly effective today, are still a life time commitment, but when the time has come, they become no more optional.  Delaying won't be of any help. But put you at risk.

You may have to enter in a  health care system of your country to get your meds, do your labs and see an I.D. Doc, but if you have the possibility to do so, you can do that abroad (such as in Thailand). If you are buying your meds abroad, ensure you are getting them from a trusted place (good hospitals, Red Cross, etc.) to avoid copies.

Please check this database on HIV specific travel and residence restriction:
http://hivtravel.org/Default.aspx?pageId=152

Excepting if you are asking for a residence permit or long stay in some countries, you don't have to provide a HIV test to get a tourist or business visa, but to fill a form. If so, I would recommend you to not say that you are positive.

About those you care about, disclosing is your choice. So far, I have disclose only to my partners and health care providers. Nothing should change for you now you are not on meds, compared to after starting meds. You doc won't tell it to any one.

Don't worry buddy, you will be fine!

J.

[emeraldize]

Sorry Steve as much as you tout your "social safety net" and iron clad privacy laws, it just simply cannot compare to Thailands crisp white uniforms and excellent use of tea and cookies.  Canada should really learn its place. 

Ahhh Buggy. If you read my post, I suggested he base his care location on urgency and encouraged Canada if that is where he spends the majority of his time. Having received care in Thailand, I wrote from experience -- not HIV care, but care nevertheless and in Bangkok---not a small town setting. The reference to garb was that it is such a throwback to US nursing uniforms in the 50s. It's striking--purely anecdotal. However, they are super-respectful of people and people's time -- and canadiandesperate wasn't certain where he would seek care. So, just like in all the other threads everyone of us tosses their best bits in. My friends in Canada like their medical care. Isn't it grand that he has two countries from which to choose?

[buginme2]

Em, I was just being sarcastic.  I realize I usually fail at being funny but sometimes I just can't help myself.  I appreciate Thailand's use of tea and cookies and their strict adherence to crisp white uniforms.  I appreciate a sense of style and decorum when I receive my health care.  Way too often the medical care in the US lacks style. 

On a more practical note, putting aside the cookies and 1950's nurses I think I would still have to choose Canada's healthcare system over Thailand's.  That's just my opinion.  The reasons for this are Thailand waiting to initiate treatment until a persons cd4 drop to 200 and their lack of using resistance testing and the choice in medications available.  However, I do agree that in the OP's case he needs to start treatment NOW.  His CD4 percentage is dangerously low.  Regardless if he chooses that care in Thailand or Canada he needs to see a doctor.

[emeraldize]

Bugsy,
Thanks much for the clarification. I agree with you re: tx and if it were my choice, I would pick Canada.
Em

[canadiandesperate]

Thank you everybody for reading and answering!

Let me get this straight.  You have been waiting for a "miracle cure".  You think the powerful and greedy PHARM industry has it in for HIV+ people and is blocking a cure?  And, you have been taking supplements thinking this could help you get to the cure date.

Listen, only 2 things determine your progression from infection to AIDS.  1) Genetics.  2) If when its your time, you take HAART, you don't get AIDS.

If I had a penny on every dollar wasted on supplements taken in the hope of fighting this virus, I'd be a multimillionaire and probably yes, a big contributor to scientific research on the AIDS CURE.

Yes I do hope for a cure soon because I want to have a love life again. Don’t want to be a big victim here but being a HIV + straight man in a very small town in a big country with not many citizens, find an HIV+ girl (on the 20 that are on dating site in my big province) it’s not a lot of option for a passionate guy like me who want someone compatible with me and not just find someone looking for someone...Many more option in the gay community (don’t want to have a prejudice here but anyone know it’s a fact). Try 2 times with a negative girl and it was a reel mess! One of them wants money to keep the secret...So yes I really hope for a cure and I’m really frustrated about the time it take to find a cure cause lack of money in that non lucrative department. I still believe in the honesty of the biologists who’s working their life on finding a cure and good medication. I’m very grateful for the work done in the meds since that shit appear from “nowhere”. And no, I didn’t think natural product will cure me, make me undetectable and will never have to take meds but I was hoping it will give me more time and time is the only thing who will make a cure possible. The miracle cure I was talking about was that they finally approve something they are working on right now so maybe the miracle was too strong...

Em, I was just being sarcastic.  I realize I usually fail at being funny but sometimes I just can't help myself.  I appreciate Thailand's use of tea and cookies and their strict adherence to crisp white uniforms.  I appreciate a sense of style and decorum when I receive my health care.  Way too often the medical care in the US lacks style. 
 

Sorry, I wasn't sure about the sarcasm 

I'm curious where you get your health care in Quebec, because I live in Montreal and our system is excellent.  I've been here four years, to the ER many times and have never encountered what you describe. I get my HIV care from the specialty clinic at CHUM and yesterday, when I needed to see a doctor, without an appointment, I was there for a total of 3 hours.  During that time I got full sinus and chest x-rays, some cultures taken and 40 minutes with an HIV specialist.

If you decide to get your care in Quebec, you should find an HIV specialist connected with a hospital. To use the example of being kept waiting in the ER, when you don't know which other types of patients were there, as a criticism of the Quebec health system is horribly unfair. Most probably, you had to wait, because you were not dying and patients are taken in order of need, not arrival.  Socialized medicine includes some compromises, but I have never heard any of my friends complain about the health care they receive.

Maybe HIV people have an advantage in the healthcare system in Quebec! This is what appears to be with what you said. Maybe is the only advantage we have! I live in a very small town without any HIV specialist 75 km around (but I have a car)...but what do you think about l’Actuel in Montreal? I hear mixed review...

It never fails to amaze me how some folks develop these really novel approaches to dealing with a life threatening disease.

Glad to amaze you! People are different in a different environment and don't live the same situation like everybody...This is why compassion is the most beautiful thing in life and judgment the worst...


And yes my first choice is to comeback in Canada for the treatment but with the plane and my health status who seem to be in a danger zone, I'm afraid of the flight like I said. We will see that in a couple of minutes with the doc here.

Seem that in the Montreal big clinic, the preferred starting meds are Prezizta with Novir and Truvada seem to be working good and not much side effect. What do you think about that?

[spacebarsux]

Mate, it's alright to wait for a cure and be hopeful as long as you go on HAART before your immune system is severely compromised and yours in getting to that point.

You do know that initiating therapy at CD4 above 350 (21%) is now recommended almost everywhere in the world, right? It is proven in clinical trials that waiting longer than this can cause you harm somewhere down the road.

Basically, don't wait to start. Not any longer.

Canada, Thailand and the logistics can be worked around later but just start asap.

PS- A lot of gay men can give straight girls stiff competition in being HIV-phobic, I think. People are people. When you meet the right person, that's all that matters- gay or straight, poz or neg.

[canadiandesperate]

PS- A lot of gay men can give straight girls stiff competition in being HIV-phobic, I think. People are people. When you meet the right person, that's all that matters- gay or straight, poz or neg.

You are right about people are people! But maybe I'm wrong but I still think when you tell a girl you are poz and she know you are straight she is way more surprise than a gay men tell to another gay men. I'm the perfect example of being straight and still catch that shit but a lot of straight people (especially girls) think it's still a gay disease sadly.

Yes I know I have to start like now but still wandering if I come back to Canada now or start treatment here and continue my trip and work for one more month. This is what I’m going to find out in couple of minutes because I’m going to see the doctor now.

Thank you spacebarsux (love your name;)

[spacebarsux]

I'm the perfect example of being straight and still catch that shit but a lot of straight people (especially girls) think it's still a gay disease sadly.

Those girls are obviously not worth your time, but then I am more gay than straight  .

All the best and let us know what your doctor says.

[sanitex]

    hello canadiandesperate,my support to you is if in case you need any more informations like hiv specialist DR
in thailand or hospital, do not hesitate to ask me or send mail i can do my best to help you. i live in thailand ok
thakx sanitex

[canadiandesperate]

    hello canadiandesperate,my support to you is if in case you need any more informations like hiv specialist DR
in thailand or hospital, do not hesitate to ask me or send mail i can do my best to help you. i live in thailand ok
thakx sanitex

Thank you very much sanitex! But time is running out for me to have more consultation in Bangkok because I leave sunday.


Well, this is the last news: I saw the doctor (maybe more of a councillor) and suggest me to start meds now with Atripla. Then I told him my story about the rest of my trip for the next 6 weeks. He suggest to have another CD4 check-up tomorrow just to be sure and if it’s not worst than 2 weeks ago he tell me that I can wait 6 more weeks and really don’t seem panic with my result for another 6 weeks without meds. I will have my result Saturday by mail and I have to take the plane Sunday for Indonesia. So I will see then but I think I will go to Indonesia at least one week (the most important week of my job) and after that maybe I will comeback. For sure, if I was in Canada now, I will start on meds right away but the story is different...I don’t even know if their Atripla is a generic and he told me they don’t have all of our medication available. So the choice is limited and I know that if I start something you have to stick with it for long time. So the final decision is not make yet but I will see Saturday.

Thank you all for your support! 

[newt]

To answer your original question, are you in great danger? the answer is no. Your CD4% is a somewhat low for your CD4 count, and suggests you should consider antiretroviral treatment soon, but waiting til you return to Canada to start medication isn't going to be a major risk. I would personally pay attention to preventing diarrhea, malaria and the like in the mean time (the usual travel precautions then).

- matt

[canadiandesperate]

To answer your original question, are you in great danger? the answer is no. Your CD4% is a somewhat low for your CD4 count, and suggests you should consider antiretroviral treatment soon, but waiting til you return to Canada to start medication isn't going to be a major risk. I would personally pay attention to preventing diarrhea, malaria and the like in the mean time (the usual travel precautions then).

- matt

Thank you Matt! And I will be careful with diarrhea. I'm always taking multi probiotique and I have activated vegetal charcoal pills in case of diarrhea and work fine with me even here in Thailand where diarrhea is a common problem for tourists even if it's the best food in the world the hygiene is not...

Not seem to be a problem for malaria where I’m going but thank you.

[newt]

multi probiotique and I have activated vegetal charcoal pills in case of diarrhea

Handwashing with soap and hot water, caution with raw food and water, no rimming, sure you know that already. Cholera and giardia don't give 2 figs about yoghurt.

- matt

[Matt39]

There is no need to panic.  

Most countries now tell people they should start meds when the tcell count goes below 500,

Not true at all. That is the point of the 'START' trials.
Not a single European country guidelines currently recommend treatment above a CD4 cell count of 350, unless the person also has a consistent CD4 % below 14% (21% is not borderline in their guidelines) *or* they are also co-infected with Hep B or C for which they are also being recommended treatment, *or* they are over 50 and have indications of a disposition to Cardio Vascular Disease, *or* they are experiencing ill-health with OIs.

So if Canadiandesperate was anywhere in Europe, he would be being monitored carefully and advised that if his current numbers drop any further over at least two testing cycles (6 months) he would be recommended to start HAART, and should now prepare himself for that possibility.
Unless he met the other criteria (Hep B/C, actual ill-health, Cardiovascular dispositions or age) he would not be recommended to start but would be offered the *option* to start straight away *if* he so wished..

[Matt39]

You do know that initiating therapy at CD4 above 350 (21%) is now recommended almost everywhere in the world, right?

Not true at all. See the answer above this one.

[mecch]

canadiandesperate has two challenges to deal with. 

One - seems to be years of somewhat denial and/or false hopes about how to battle HIV.  So psychological/emotional. 

Two - where and how to enter treatment phase, now that his numbers are indicated its about time. so medical and strategic - where to work, live, and get treatment - so how to live with HIV in the treatment phase of our lives.

I don't think members are encouraging him to panic but yes, time to face reality and start some decisions.

Matt39, is it my false memory, or do I notice you  show up in such threads when people are dealing with the two challenges and -- though your agenda is not outright anti-haart, there is something counter-productive about the discourse. 

Well anyway, its all well and good if canadianD continues to actively deal with the two challenges, without too much panic.

[Matt39]

Matt39, is it my false memory, or do I notice you  show up in such threads when people are dealing with the two challenges and -- though your agenda is not outright anti-haart, there is something counter-productive about the discourse.  

I was simply pointing out a glaring inaccuracy in two posts.

He asked simply if he was in danger now not being on HAART, and apart from the fact no one here actually is qualified to say either way, the fact is his numbers alone under guidelines operating in most of the world apart from North America, don't indicate that and if he is not also co-infected with Hep B or C and he is not suffering any ill-health then his situation is sufficiently fine for him to come to a considered and calm decision.

It is critical that canadiandesperate is given *accurate* information - if he is told his numbers are actually critically bad and, in any case, everywhere in the 'world' the advice is to go on HAART straight-away (which they are not and it isn't) he is getting inaccurate judgemental information from people who are not qualified to give it.

And it is critical that he does not get panicked or driven into a state of fear or extreme stress, let alone depression, because those states *are* immuno suppressive and they *are* a trigger for ill-health, even in the HIV negative population.

Only he will know what his overall health has been over the last few weeks and months and that is important for him to keep close to, and unless it has been poor he can count a positive situation.

There is no urgency for him to begin any treatment before he returns to Canada, if he wishes to wait, and to engender a feeling in him that he *must* is not supportive or responsible.
Adherence to ARVs is critical, and adherence is almost always fragile when people feel bumped into it too quickly.

So taking his circumstances into account means supporting him to be calm and considered.

Try doing that instead.

[newt]

Most countries now tell people they should start meds when the tcell count goes below 500,

Other Matt is correct, only in the US is this routine advice, it's 350 elsewhere.

if Canadiandesperate was anywhere in Europe, he would be being monitored carefully and advised that if his current numbers drop any further over at least two testing cycles (6 months) he would be recommended to start HAART

But I think not on this one, at a CD4 count around 360-370 and a CD4% of 15 I believe most docs in Europe, and all docs in my clinic, would be moving for an immediate retest to check this is the real level, and if so talking about starting combination therapy ASAP.

- matt

[Matt39]

Other Matt is correct, only in the US is this routine advice, it's 350 elsewhere.

But I think not on this one, at a CD4 count around 360-370 and a CD4% of 15 I believe most docs in Europe, and all docs in my clinic, would be moving for an immediate retest to check this is the real level, and if so talking about starting combination therapy ASAP.

- matt

I'm grateful to you for confirming the current guidelines outside of the USA.

As for the specific numbers and percentages for canadiandesperate I would beg to differ, at least as far as the UK is concerned.
One CD4 count of 360-70 on its own (even with a percentage of 15%) is statistically insignificant. The BHIVA (British HIV Assoc) guidelines - which the National Institute for Health & Clinical Excellence concurs with - view those initial figures as the time to prepare a person for potentially imminent decision on whether or not to start HAART, but without co-infection with Hep B or C *and* a recommendation for treatment for those *or* current ill-health with specific OIs *or* co-factors around age and specific factors for Cardiovascular disease, they would still need to see a trend or consistency over two testing periods. They may well want an earlier retesting - at 8-10 weeks rather than a further 12-13 weeks. And of course, if a person pro-actively wanted to start HAART (even at higher whole numbers and percentage than 370/15%) that option would almost certainly be agreed to.
The important thing for the HIV Specialist would be seeing a consistency to the numbers and preparing the person, in order to achieve start for HAART at the best possible time for the person (work wise, location etc) in order to ensure the best possible chance of early consistent adherence.

I know from my own HIV Consultant who is the Lead HIV Clinician in a major London HIV Clinic, that his approach is pretty much as I described above, and I know from my work with the patient support group there that it is a tried and trusted approach that fits well in supporting people.

That kind of sound basis for person treatment is not helped by individualistic judgements shown by many comments here, and talk of 'denial' or 'you must get on them now!' is virtually never anything but potentially harmful and unhelpful.

[bocker3]

canadiandesperate has two challenges to deal with. 

One - seems to be years of somewhat denial and/or false hopes about how to battle HIV.  So psychological/emotional. 

Two - where and how to enter treatment phase, now that his numbers are indicated its about time. so medical and strategic - where to work, live, and get treatment - so how to live with HIV in the treatment phase of our lives.

I don't think members are encouraging him to panic but yes, time to face reality and start some decisions.

Matt39, is it my false memory, or do I notice you  show up in such threads when people are dealing with the two challenges and -- though your agenda is not outright anti-haart, there is something counter-productive about the discourse. 

Well anyway, its all well and good if canadianD continues to actively deal with the two challenges, without too much panic.

I am completely aligned with this thought.  Matt39 only comes into threads to discourage people on the fence of starting treatment (and to throw around all the "experts" that is friends or acquainted with).  The fact is that treatment IS moving to earlier and while very few have said he "must" start -- they are saying it is time to seriously consider it.  Even Ann, who is always a voice for starting ONLY when one's number truly indicate it has weighed in here.  No, we are not experts -- but then neither is Matt39, despite all his imaginary illumiinaries -- but he didn't ask experts, he asked us.  Oh -- and from his name, I'm guessing the OP isn't from Europe.

To the OP -- if it were me, I would be starting meds now -- so long as you are ready to take on the responsibility of taking them for the long haul here.

Good luck and try not to let people like Matt39 and his agenda dissuade you from doing what is right for YOUR health.

Mike

[Matt39]

I am completely aligned with this thought. 
Mike

Good for you. Thank goodness then that there different thoughts and that this forum is not really a hostage to a an Orwellian 'one truth', even if it sometimes appears like that.

[newt]

One CD4 count of 360-70 on its own (even with a percentage of 15%) is statistically insignificant.

But clinically not perhaps, which is the point. CD4 of 15% is well under the recommended starting treatment threshold, and British guidelines are careful to point out the importance of bearing in mind mismatched CD4 count/CD4% figures.  I stick to my previous statement that I believe an immediate retest to check this is the real level, and if so talking about starting combination therapy ASAP, is a likely outcome. Clearly in the end it's up to the person concerned, and some will choose to wait, some to start. Me personally, with these numbers I would be looking to start ASAP, but not fretting too much about a few weeks travelling around the world.

- matt

Now playing: the rainy, cold weather forecast for Bank Holiday weekend

[Matt39]

But clinically not perhaps, which is the point. CD4 of 15% is well under the recommended starting treatment threshold...

Me personally, with these numbers I would be looking to start ASAP, but not fretting too much about a few weeks travelling around the world.

- matt

It's 13% or below -  it's plastered all over the walls of HIV clinics in the UK and on leaflets and magazines, so 15% is still above.

But I agree with your last sentence, if I was the OP I'd be calmly looking to see if those numbers were the same when I got back to my home city preparing myself for the decision that, if they were, I would be discussing a HAART start date and what combination I was prepared to start with.

[bocker3]

Good for you. Thank goodness then that there different thoughts and that this forum is not really a hostage to a an Orwellian 'one truth', even if it sometimes appears like that.

You missed my point I think -- I was aligned with the thought that you only come in to specific threads -- namely those that you can try and talk someone out of starting HAART (while you pop your pills each and every day).

and............  your tired old whine about an "Orwellian one truth" simply doesn't hold up.  Many folks have differing opinions on when to start treatment.  The only thing being done here is countering your absurd notion that HAART is evil for others, but you will continue to take your own.  (cue:  here is where you throw out another name of some expert who you go to the pub with each night).

M

[Rev. Moon]

cue:  here is where you throw out another name of some expert who you go to the pub with each night

No Mike, this is the point where he brings up the Nazis.  Cause that's what he does all the time, him and his tired line of thinking.  Like seriously, does this person think that he sounds clever just by throwing the word "Orwellian" in all of his argumentative replies?

[John2038]

Recommendations for initiation of therapy in naive HIV-infected patients

• 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) > 100'000 c/ml or high cardiovascular risk

http://www.europeanaidsclinicalsociety.org/index.php?option=com_content&view=article&id=59&Itemid=41

In conclusion:
Accordingly to the latest EACS above, for patients with VL > 100'000 c/ml, treatment is recommended (as much as they are for patients with CD4 < 350).
In more, CD4% < 14 means AIDS, and most of the Guidelines worldwide would recommend starting a treatment as well.

Also, taking into account:

• Accumulating data from observational cohort analyses suggest benefits to starting when CD4+ cell counts 350-500 cells/mm3
• • Survival benefit
  • Fewer AIDS-defining events
• NA-ACCORD data suggest survival benefit of starting ART at even higher CD4+ cell counts (> 500 cells/mm3)

ART CC: Analysis of 15 cohorts from US and Europe (ART Cohort Collaboration) (N = 24,444)

Comparison	HR (95% CI)
1-100 vs 101-200	3.35 (2.99-3.75)
101-200 vs 201-300	2.21 (1.91-2.56)
201-300 vs 301-400	1.34 (1.12-1.61)
251-350 vs 351-450	1.28 (1.04-1.57)
351-450 vs 451-550	0.99 (0.76-1.29)

Source: Sterne J, et al. CROI 2009. Abstract 72LB

Another interesting study highlight the benefit staying with CD4 > 500.

• Overall mortality in HIV-infected patients 7-fold higher than general population
  
• After 6th year of follow-up, mortality among patients with CD4+ cell counts ≥ 500 cells/mm3 comparable to that of the general population

Source: Lewden C, et al. J Acquir Immune Defic Syndr. 2007;46:72-77


Based on that, his counts and in particular VL, it is obvious canadiandesperate should start a treatment.
He got also 28% more chance of getting AD compared to pts starting at >450.
No needs to add the others recents studies suggesting the earlier the better, nor those highlightinh others benefits in terms of lower side effects, better immune recovery, and so.

Note:
International HIV Care, Treatment, and Prevention Guidelines
http://hivinsite.ucsf.edu/global?page=cr-00-04

[newt]

It's 13% or below

Is what UK guidelines say (<14% etc to quote) ... indeed, but it's a rough guide not an absolute figure, and if my doc was not vigilant at a CD4% of 15 I'd be kicking his ass in the Thames, this is more or less the threshold for a high risk of PCP << a life-threatening condition, so 12, 13, 14, 15%, it's a moot point. Now tell me, which doc in the world is gonna fret about +1-2% on a CD4%? Erm none I want to be treated with. Erm none, in short. Rest my case. Can we get back to the OP's point now?

- matt

[canadiandesperate]

Thank you all for your opinion and some fact, the good and the bad one. Forum and my presence here is all about that and I read and analyse every of your messages, even if I don’t understand everything because of language barrier.

First, I’m little bit under 40, no heart problem known, no hep A or B, last time I was check no Hep C but yesterday I do a lot of STD (so hep C) test and another CD4 test. I still don’t have the result yet but suppose to be tomorrow.

I know I have to relax because stress is not good for me. So even the person who’s talking and say it’s best to  start meds near or over 500 it’s too late for me anyway. And for the little I know about meds, lot of meds and long time meds damage your liver (like every other kind of meds) and your heart. So maybe starting earlier is better for some fact and not good for other fact like killing your liver and your heart. This is why there is two different approach in the professional field. Yes maybe some don’t care about damaging your liver and your heart and just want you to take more pill$ for long time. At my point, I don’t really care about the fuc**** gimmick of the Pharm company and the very sceptical FDA, lobbying and stuff like that, I know I have to start meds ASAP. Like I said before, if I was in Canada right now, I will start right away. I’m ready and no more denial for me like in the first 6 month of the news that I learn because I infected a nice girl and mother of 3 child and learning with that fact that I was infected by another nice girl I’ve known for many years who did not know at that time. A kind of shock yes! And have to tell 4 other girls they may be infected because of me and wait for the result with them. A real nightmare! Even with my “denial” at the beginning that it’s not possible that shit happen to us (especially the mother of 3 I’ve infected) I still tell those 4 girls right away face to face 1 at a time, 1 by a day because it’s was too hard. Thank god no more was infected but a long 4 weeks and for another 2 months of waiting. The fact that I didn’t want to enter in the healthcare system in Quebec have nothing to do with denial. It’s for professional and personnel reasons, a couple of them still there but no more of an issue at my point.

Yesterday I change my flight and I’m going back in 4 weeks instead of 6. It was the better I can get under 500$ penalty fee cause sooner was 2000$! And also my job will be done at that time, so no very big stress about inventing a reason to my boss for comeback earlier. I didn’t want to start my meds here for a couple of reason (don’t have all the meds so cannot give me the choice), don’t want to have side effects in Indonesia where I really don’t want to be treated. So I will see a doctor in Quebec as soon as I comeback and start in the doctor office if I can! Now you just have to wish me luck that nothing happen before I got back in 4 weeks and please stop talking about the disease I’m risking to catch and die because it will not help my situation. I will be glad then to salute you all and share what kind of meds I’m on and try to get back on normal life again when I get back in Quebec. And I don’t care about taking meds every day (if I don’t have side effects) that remind me I have that shit in my body because I already think about it every single day and especially think about the girl I infected. So I think that denial is far behind now but psychological issue maybe not but I will seek for help in Quebec too at the same time.

Thank you all, I will share my result as soon as I got it.   

[Ann]

What some people seem to be forgetting is the OP's high viral load. He reported that last year, it was 572,331 and this year it was 758,165. If he were very newly infected that number wouldn't worry me so much, but he's been poz for a few years now.

To me, it is no surprise that he had such a drop in CD4s, particularly that drop in CD4% - due to the high VL. That is why, in this case, I have suggested that his numbers do indicate the need to start treatment.

In the past year or two I have had several "when to start" discussions with several different doctors at my clinic in Liverpool. I feel it is safe to say they would all agree that the OP's numbers do indicate the need to start treatment, sooner rather than later. I know that high viral load and drop in CD4% would definitely have me clamouring to start.

From my recent discussions, I also believe that starting with his numbers as they are (ie high VL and low CD4%) would be totally acceptable from the point of view of the BHIVA. (British HIV Association)

[Matt39]

Thank you all for your opinion and some fact, the good and the bad one. Forum and my presence here is all about that and I read and analyse every of your messages, even if I don’t understand everything because of language barrier.

First, I’m little bit under 40, no heart problem known, no hep A or B, last time I was check no Hep C but yesterday I do a lot of STD (so hep C) test and another CD4 test. I still don’t have the result yet but suppose to be tomorrow.

I know I have to relax because stress is not good for me. So even the person who’s talking and say it’s best to  start meds near or over 500 it’s too late for me anyway. And for the little I know about meds, lot of meds and long time meds damage your liver (like every other kind of meds) and your heart. So maybe starting earlier is better for some fact and not good for other fact like killing your liver and your heart. This is why there is two different approach in the professional field. Yes maybe some don’t care about damaging your liver and your heart and just want you to take more pill$ for long time. At my point, I don’t really care about the fuc**** gimmick of the Pharm company and the very sceptical FDA, lobbying and stuff like that, I know I have to start meds ASAP. Like I said before, if I was in Canada right now, I will start right away. I’m ready and no more denial for me like in the first 6 month of the news that I learn because I infected a nice girl and mother of 3 child and learning with that fact that I was infected by another nice girl I’ve known for many years who did not know at that time. A kind of shock yes! And have to tell 4 other girls they may be infected because of me and wait for the result with them. A real nightmare! Even with my “denial” at the beginning that it’s not possible that shit happen to us (especially the mother of 3 I’ve infected) I still tell those 4 girls right away face to face 1 at a time, 1 by a day because it’s was too hard. Thank god no more was infected but a long 4 weeks and for another 2 months of waiting. The fact that I didn’t want to enter in the healthcare system in Quebec have nothing to do with denial. It’s for professional and personnel reasons, a couple of them still there but no more of an issue at my point.

Yesterday I change my flight and I’m going back in 4 weeks instead of 6. It was the better I can get under 500$ penalty fee cause sooner was 2000$! And also my job will be done at that time, so no very big stress about inventing a reason to my boss for comeback earlier. I didn’t want to start my meds here for a couple of reason (don’t have all the meds so cannot give me the choice), don’t want to have side effects in Indonesia where I really don’t want to be treated. So I will see a doctor in Quebec as soon as I comeback and start in the doctor office if I can! Now you just have to wish me luck that nothing happen before I got back in 4 weeks and please stop talking about the disease I’m risking to catch and die because it will not help my situation. I will be glad then to salute you all and share what kind of meds I’m on and try to get back on normal life again when I get back in Quebec. And I don’t care about taking meds every day (if I don’t have side effects) that remind me I have that shit in my body because I already think about it every single day and especially think about the girl I infected. So I think that denial is far behind now but psychological issue maybe not but I will seek for help in Quebec too at the same time.

Thank you all, I will share my result as soon as I got it.   

I think your post above is exceptionally well thought out, realistic and sensible and I am sure when you return to Canada, you can sit down with a specialist get retested and decide what regimen to begin with.
One thing I would urge you to ask your HIV Specialist to do, is include a test for your Vitamin D level 50ug or above being what it should be, and have a bone mineral density scan (Dexa scan) to use as a baseline to monitor once you are on HAART, since in men our age this is particularly important. It should be automatic and with some HIV Specialists it is but for some not, so a gentle nudge to him/her is worth it. You can read the articles by Sean Strub here on poz.com for more information on that.

I wish you all the very best of luck.

[canadiandesperate]

Thank you Ann for your concern. I know it's true what you write and I also know that my CD4 will continu to drop because of my high level of VL. The doc here already told me. The only thing I can do from now on, is to hope that everything will be fine for me the next 4 weeks. By the way, I love your avatar! 

Thank you Matt39, I will.

[mecch]

I am glad that it has been a few years now that you have been getting labs.

The semi-denial I was thinking of is not that you were in denial that you were HIV+.   Instead, what I noticed was that you were not ready to face few things one can't avoid if one is HIV+.  Accepting it, living with it, and fighting the virus appropriately.

You have expressed SO many anxieties in this thread about your situation, both in these days (maybe a “great danger” for health, losing job, being deported, etc) but also in the 4 years since your seroconversion.

The way you report your seroconverison itself is not clear.  First it seems like you AND the medical system didn’t even find out you were seroconverting when it happened.  I think this surely happens sometimes with heterosexuals!  

But then I got confused -- because you said you were worried about just one girl (woman you might say) for a risk.  But later in the thread, it becomes clear there was one woman who infected you, and then you passed it to another woman, out of 5 total woman, besides the (6th, therefore) who passed it to you.  (4 did not get it.  Good!)

So then you explain that yes, you were in denial for about 6 months after the seroconversion.  Continuing to have unsafesex I guess.  Did you even have your diagnosis at that time?

But, you did some good things too, which show you were not in denial eventually, about being HIV+.  You disclosed to your partners who were at risk.  That was the right and mature thing to do.  

By the way, eventually you may consider that HIV is a virus with no morals!  

You are not “responsible” for the woman who got it from you, at least not fully.  

All 6 woman, and you, were having unsafe sex and making assumptions about the lack of HIV risk, and that was naïve and ignorant of each person.  

And each person is responsible for the decisions he/she makes, and for his or her own naiveté about HIV in the heterosexual world.   So I hope in the future this becomes less of a burden for you.  You only have to worry about your own actions.  

SO, then over the 4 years, while you knew you were HIV+, there was a lot of anxiety about being HIV+ and how it will effect your LOVE LIFE; and your job, and how to enter the medical system.

You seemed to think a love life was not possible being HIV+ and a passionate straight man.  But listen, its probably true that your pool of potential partners has gone down, but really, the same thing happens for gay men. And straight or gay women. HIV+ people are all in the same boat for this downside of being +.  Some people just don't want us.  Look on the bright side however.  Based on the sexual success your report, you must be a charmer and a good looker, so you have that still!  I have a good friend since childhood, in our teens, she became VERY "striking" and not really what the average US teenboy wanted in a girl.  This lasted a good 15 years. Her pool of dating was much lower than mine.  

Everyone has advantages and disadvantages in the dating game.  Even the advantages can be a drag.  I know an handsome smart young man from a billionaire family and so many of the women he meets, they treat him as a potential bank account.  I knew this gorgeous girl in college, every time we went to a disco, the handsome guys were intimidated but EVERY average schmuck in the room for some reason thought he had a chance and would go for it.  By the way, she ended up with a very charming successful but dumpy average looking guy.

Secondly, you seemed almost to say that being in the medical system was a way that your status was going to be known – cause you know nurses and so on, and thus gossip would be a way of you losing control of your privacy, and also hurting your dating pool.   How much this is true I can’t tell – surely it’s a risk and we have heard such stories in this forum.  Maybe you are part of a special community where everyone knows everyone so word travels fast?  

But that doesn’t matter, eventually, as you see now.  Health comes first, and you deal with the stigmas and discrimination, when they might arise.  Otherwise you die.

Then several times your repeated about the hope for a cure to save you from “really being HIV+” in my words, as if the miracle might come along and the nightmare would be over for you.  Back in business.   This was wishful immature thinking.  Its good that now you realize that its not going to happen in time for you to avoid HAART.  

You can still be hopeful for a cure, but these things move slowly, we are 25+ years into the epidemic.

You have some displacement of the fears about the reality of living with HIV onto fears/beliefs about PHARMA industry, and about the medicine.  And some ignorance about the ability of supplements to fight various diseases.  

So that is another reason, reading between the lines, I suggested you are coming out of a period of some denial about the basic facts of HIV.

The basic facts about HIV are

1) that it is a virus, and it has no morals.  The stigma and discrimination that comes to those who are HIV+ - this is very real but it based on beliefs, ignorance and morality of people expressing the stigma and enacting the discrimination.  There are in fact other STD – sexually transmittable diseases, that have very little ENDURING impact as regards stigma and discrimination for people who have had them.   Gee, do you think anyone cares who has had a case of the “clap” sometime in their lives.   Or anal warts?  

You are not a bad person for being HIV+.  Love and relationships are possible for HIV+ people.  

OK the dating pool may be a bit trickier.  

Disclosure or not, and the resulting stigma or discrimination, these are maybe bigger challenges for an HIV+ person than the medical ones.

At least for someone who is a relatively recent infection.  Has known since seroconversion.  And can live in a country where there is good and affordable healthcare.  

YOU need to find strength that YOU are in that category of very fortunate people with HIV.

2)  HIV progresses to AIDS mostly because of genetics.  There are no proven effective supplements.  No diet.  No psychological lifestyle.  No spiritual beliefs.  Trust on this.  

We in the over 40 club – many of us saw almost everyone HIV+ eventually die, in the 80s or 90’s except a select few.  And for the select few, there was no particular ACTION they took to survive, it was because of genetics – very slow progressors, or maybe because one or two made it , while quite sick, to early drugs which in fact did NOT kill them, like the drugs did, yes, poison others, etc etc.    

3)  Start learning about HAART therapy as it exists TODAY.  Be very careful reading about HAART or listening to peoples experiences with HAART – if the information about HAART is about for from the 90’s, or even HAART in 2000.  This does NOT speak to the experience you are going to have, treated in Canada.

HAART is not poison.  Regarding number 2 (genetics) – HAART is the only action an HIV+ person can take that stops progression to AIDS when a person is progressing to AIDS.   Nothing else.  Only option.  

Wishing you well.  

[Matt39]

You have some displacement of the fears about the reality of living with HIV onto fears/beliefs about PHARMA industry, and about the medicine.  And some ignorance about the ability of supplements to fight various diseases.  

1. Several double-blind placebo controlled randomized scientific clinical trials involving both probiotic and prebiotic supplementation over the past ten years have shown restriction in decline and elevated CD4 counts in HIV+ people, independent of HAART, especially the 'BITE' trial in late autumn 2010 - these trials and links have already been posted several times in threads in the 'Nutrition' forum here

2. Deficiencies in Selenium, Glutathione and Vitamin D have been proven - in scientific clinical trials - to have a bearing on illness in HIV+ people and have been clinically and scientifically proven to be a reliable predictor of ill-health, independent of HAART.
Pharmaceutical grade supplements, under medical supervision, of Selenium and Vitamin D (where deficiency is proven by test) have been proven in clinical trials to improve immune performance, independent of HAART.
IV Glutathione under medical supervision, or oral supplementation of Gluthathione precursors (N Acetyl Cysteine, Alpha Lipoic Acid, Undenatured Whey Protein) have been clinically proven - in HIV+ people - to enhance the body's capacity to create Glutathione and restore it to optimum levels, as the body creates less as we age even in the HIV Neg - Glutathione is the most powerful anti-oxidant known to man. Oxidative stress (ie oxidation) is one of the most well known and serious clinically proven reasons for ill-health and  immune suppression, independent of HAART.

In fact, it has been clinically proven, that the above actions go a long way to guarding against many of the long term side effects of HAART, such as bone mineral density loss and liver and kidney dysfunction and cardio vascular disease.
This is especially important since Liver failure is the biggest single cause of death in HIV+ people on HAART, closely followed by heart failure - the number who actually die of 'AIDS-defining illnesses' is tiny by comparison.

Some references:

Low Vitamin D Levels Associated With Serious HIV Disease Progression:
http://www.aidsmeds.com/articles/hiv_vitamind_heart_1667_20373.shtml
BITE Trial on prebiotic supplementation in HIV+ people to restore optimum Gut Function and immune enhancement:
http://www.natap.org/2011/CROI/croi_78.htm
Administration of N-acetylcysteine (NAC) to replenish glutathione (GSA) deficiency, improves T-cell function and blocks HIV expression in vitro.
http://www.medibolics.com/NAC-GSH.htm
Quote: "N-acetyl cysteine is one of the dietary supplements that those HIV(+) people in the know have been taking for a dozen or more years"
N-acetylcysteine replenishes glutathione in HIV infection:
http://www.ncbi.nlm.nih.gov/pubmed/11029607

[John2038]

The priority here would be HAART. What is your point recommending supplements and suggesting HAART isn't needed yet, with such VL and borderlines counts? HAART + some supplements if fine. Not just supplements.

[Matt39]

The priority here would be HAART. What is your point recommending supplements and suggesting HAART isn't needed yet, with such VL and borderlines counts? HAART + some supplements if fine. Not just supplements.

Open your eyes. I never suggested any supplements or even alone because if you read carefully it says 'where deficiency is proven (to exist) by test'. I was responding to someone's else's post. And if you read my post with any real effort, you will find I comment on supplements while on HAART. You will also find all my referenced links are OFFICIAL HIV RESEARCH links.
And if you scroll up a couple of posts before you'll I see agree with the OP discussing starting HAART with his Canadian specialist.
It is always better to read your post before hitting 'submit' - if you had done that you could have avoided your multiple inaccuracies.
Good luck

[John2038]

Not true at all. That is the point of the 'START' trials.
Not a single European country guidelines currently recommend treatment above a CD4 cell count of 350, unless the person also has a consistent CD4 % below 14% (21% is not borderline in their guidelines) *or* they are also co-infected with Hep B or C for which they are also being recommended treatment, *or* they are over 50 and have indications of a disposition to Cardio Vascular Disease, *or* they are experiencing ill-health with OIs.

So if Canadiandesperate was anywhere in Europe, he would be being monitored carefully and advised that if his current numbers drop any further over at least two testing cycles (6 months) he would be recommended to start HAART, and should now prepare himself for that possibility.
Unless he met the other criteria (Hep B/C, actual ill-health, Cardiovascular dispositions or age) he would not be recommended to start but would be offered the *option* to start straight away *if* he so wished..

Here you haven't mention the VL, which lead to recommending initiating HAART in the EACS.
Maybe you would like to read the recommendations carefully before providing others with your own recommendations. You can rephrase or reconsider later on, everybody make mistakes, but then being assertive is not serving you weill.
I'm not shouting at you at all. Yeah, it may seems, but its not my intend. I just wishes you to be more open to others opinions so that we keep a good spirit in this forum.
Still, the counts of canadiandesperate strongly suggest starting HAART. And the sooner the better. And even much earlier (<500)  accordingly the the US Guidelines. But guidelines are not all. And only an ID doc will make the rights recommendations.

Best n peace

[Matt39]

Still, the counts of canadiandesperate strongly suggest starting HAART.

John

I have read many of your posts to try and get an understanding of where you are coming from and why you have completely misread my previous post in response to mecch.
I have come to the conclusion that you are an HIV Science obsessive, don't really understand it, and that, along with English not being your native language, has made you misread posts and respond in an inaccurate way.
If you can't go back and re-read my posts where I *agree* that the OP should discuss starting HAART, then just don't reply at all.

Good luck

[John2038]

It's about the duality of your posts. Nevermind.

Note: I still think you shouldn't try to be assertive (nor now to rule), but to be constructive.

I hopes we will have nice conversations in this forum.

[buginme2]

The OP already said he was going to seek treatment in canada shortly so he will most likely be started on meds straight away.  Especially since much of Canada has as strict or even more strict treatment guidelines as the US.'

Matt, what comes across to me is that you often times seem to advocate for delaying treatment.  You quote studies and ask people to read blogs by Sean Strub (who also advocates that people delay treatment and often speaks of the dangers of haart).  If that is your position thats fine, just say so.  You have a right to beleive that.  I would only ask that you consider that many people do not share your view (most probably don't).  Your posts do seem aggressive in their attempt to get others to follow your line of thinking.   That may be what John is trying to say. Dismissing him as being HIV science obsessive and not understanding english doesnt hold water.

[Matt39]

Dismissing him as being HIV science obsessive and not understanding english doesnt hold water.

Actually it does because John is obsessive, doesn't read english well at all (my own posts are very clear supporting the OP in starting HAART when he returns to Canada if his numbers are the same), and there are multiple posts in reply to him going back 3 years saying exactly the same thing.
As for the co-founder of Poz Magazine Sean Strub's blog - he is a long termer with a wealth of *actual* experience (contrary to many here who post on HAART without *any* experience of it) - he has a contribution that is valid and widely respected, and a lot more than many others.
Sean Strub also happens to believe that many posts here that twist an 'opinion' into being attacked as something that is 'aggressive' (like yours) are negative and counter productive.

Good luck

[mecch]

Sean Strub also happens to believe that many posts here that twist an 'opinion' into being attacked as something that is 'aggressive' (like yours) are negative and counter productive.

Good luck

Matt39 your appearance and contribution to this thread just shows everyone that certain of us have your M.o. -  which we feel is counterproductive, somehow, in the end, in precise situations a particular OP is experiencing.  

It may also prove that you know that we have this opinion and that you are looking for arguments with members, above and beyond (what you claim is) helping an OP (but I for one think is messing with an OP).   You'll say something clearly reasonable, and argue how can we ignore that, or you'll say something really counterproductive to the OP, with a cleverly timed walk back so you can show a bit later on you didn't really say what you said before you walked it back.  

Also, in every thread, a few people who do engage with your rabbit hole rhetoric,  will earn the superior and queeny "final dismissal" (which is also a kind of flame-bait).   In fact each apparition feels like meta flamebait to forum members and a maybe cruel, always somehow counterproductive lure to the OPs.

Perhaps you don't realise your M.o.  I had to laugh twice at your misread of Bocker.  Once because it showed your delusion and a second time cause of the little irony that Bocker and I hardly ever see eye to eye but can agree on your M.o.

Also i feel dirty and like a jerk for calling you out in this thread.  Someone will do it cause we want newbies in general or an OP to see your agenda, the context -- as they are beginning to  educate themselves about the role medical care and research-based science will have to play in their OWN lives, living with HIV.    Slimed by you because yes, eventually other members will chime in when one of us calls out your M.o, so there will be flamebaiting and you'll capture energy that little us of want to give you.  Jerky because it leads to hijacks, confuses people, leads to meta-conversations not everyone can follow, least of all newbies and often times the OP.   Ick.  Ew.

[bocker3]

Perhaps you don't realise your M.o.  I had to laugh twice at your misread of Bocker.  Once because it showed your delusion and a second time cause of the little irony that Bocker and I hardly ever see eye to eye but can agree on your M.o.

And what happens the week that I agree with you -- first an 5.8 earthquake and now a hurricane raging outside.   

Seriously though -- most people "get" Matt39's angle.  The unfortunate thing is that he tends to prey on the vulnerable by jumping into threads where folks are on the fence.  Plus, while he is sure to drop a name of some "illuminary in the field", he rarely ever mentions the fact that he takes his HAART everyday -- nor have I ever seen at what point he decided to start.  But then, these "facts" wouldn't help his pot stirring.

Mike

[AnnieInBC]

Hi canadiandesperate

I hope everything goes fine for you when you get back to Canada and you can find some calm time to organise yourself, find a Doc and service you trust and when they test you again, make your decision with all the information, including that provided here. I have been through the same so I can empathise with what you are going through.

I have been reading here for a long time but never registered to post before. But I felt compelled to do that today because I have been shocked by the manner of some. There are posts here by people who clearly wanted to give you support and consideration and information, whatever 'side' they came down on. But there are also those who seem to take pleasure (or just angst and defensiveness) in attacking someone who wanted to give you a view that these others simply don't like, and so they attributed motivations and intent to matt39 that seemed to me simply unwarranted. I don't think people who are so quick to 'attack' are the ones best placed to give advice. I certainly would stop reading them the moment I read such vitriol.
I hope you are able to take a more considered view of the all the information you have.

Good luck

Annie x

[Sean Strub]

I'm a bit late to this conversation, but since my name has been mentioned, I thought I would clarify a few things about my own views.

I don't advocate delaying treatment as a general rule; that is an individual decision that is informed by many different factors.  I waited to start treatment longer than most of the recognized experts would have thought was appropriate.  My decision to delay was an informed one and one I do not regret.  Informed is the operative word.

I do think some people are on treatment who probably do not need to be on treatment and I think some people are on more treatment than is necessary to achieve suppression of the virus to undetectable levels.  At present I am on a regimen that most clinicians and treatment experts would consider inadequate.  For the last several years I have taken 400 mg of Prezista and 100 mg of Norvir once a day.  That is significantly less than the recommended dosage of Prezista, but it has been effective for me and has kept me undetectable.

I am alive because I take anti-retroviral therapy.   I am also alive because I refused to take it when it was first prescribed for me and I was able to minimize accumulated toxicities and avoid the resistance that so frequently resulted from mono or duo therapy.  My experience is that cumulative side effects, over time, are almost always worse than what is required on the prescribing indication when a drug is initially approved. 

While the newer drugs and regimens are more effective and generally less toxic than the worst of the old ones, many people will still develop very serious side effects from therapy, including many people who are just commencing therapy today.  We know more about these side effects than ever before, but there is an ocean of knowledge we don't yet have and it is clear that there are side effects that don't show up for years and years, decades even, after one commences therapy. 

I have about half the bone density that I should have, for someone my age and gender.  Bone loss is multi-factorial, but I am certain one of the major factors in my bone loss was taking Viread (and too much of it) for five or six years.  Other HIV meds, maybe even most of them, are also demineralizers, but the evidence is most damning to Viread's role.

There is a phenomenon in discussing treatment strategies that too often boils down to people believing their own position is the only correct one.  I've been positive for more than three decades.  Like many on this site, I've known hundreds of people who have died and hundreds who have survived.  I have seen many, many, many different paths to survival, including some unorthodox ones.  The most successful survivors, in my experience, are those who become very well-informed, remain skeptical and are constantly listening to and learning from others who have HIV. 

Whenever anyone gets overly argumentative about a treatment strategy, or starts attacking the motives of another person with HIV in discussing treatment strategies, I tend to turn off.  Widely accepted conventional wisdoms about AIDS often are shaped by priorities other than the best interests of people with HIV.  Sometimes those conventional wisdoms get turned on their head.  Other people with HIV--including those with whom I've disagreed--have been the best source of information for me in learning how to manage HIV.  That has always been the case, since the first days of the epidemic, and remains so today, at least it does so for me. 

I disagree with those who claim that supplements, lifestyle issues, diet, faith, etc., have nothing to do with progression of the disease.  In the individual situations I have been most intimately familiar with, those non-pharmaceutical therapies or coping strategies or whatever one wants to call them have often been extremely important and have played a significant role in delaying progression of the disease, mitigating side effects of anti-retroviral therapy and/or improving quality of life. 

Finally, I hope posters will be more generous to those who point out the downsides of anti-retroviral therapy or who are skeptical of early treatment.  I don't know about his posts on other threads, but the poster (Matt39) who was accused of "preying" on newbies with his skepticism about early treatment I thought was characterized unfairly. 

I didn't find his posts on this thread to be the least bit inappropriate and I agreed with almost everything he said.  People who are considering treatment need to understand the breadth of opinion and experience those of us with HIV have had with treatment, side effects, etc. 

Good luck to the OP; you've gotten a lot of good information in this thread and it sounds like you're going about your own treatment decision making in a smart way.

[Miss Philicia]

Finally, I hope posters will be more generous to those who point out the downsides of anti-retroviral therapy or who are skeptical of early treatment.  I don't know about his posts on other threads, but the poster (Matt39) who was accused of "preying" on newbies with his skepticism about early treatment I thought was characterized unfairly. 

I didn't find his posts on this thread to be the least bit inappropriate and I agreed with almost everything he said.  People who are considering treatment need to understand the breadth of opinion and experience those of us with HIV have had with treatment, side effects, etc. 

That's all well and good, but fyi matt39 was banned by the moderators for trolling this forum under a handful of user names, including putting forward AIDS denialist postings.

[Ann]

Sean, Matt39 and his sockpuppets AnnieinBC and Rizdaddy have all been banned. He showed his denialist colours in technicolor glory as Rizdaddy, but you won't be able to see those posts as they are in the bin. Let's just say he a fan of a certain documentary produced by voracious denialists. It's a shame he uses your name to try to give credence to his ludicrous, mistaken and downright dangerous beliefs. In true denialist style, he twists, cherry-picks, misrepresents and takes facts out of context to try to dissuade people from taking meds at all.

[jkinatl2]

Sean, Matt39 and his sockpuppets AnnieinBC and Rizdaddy have all been banned. He showed his denialist colours in technicolor glory as Rizdaddy, but you won't be able to see those posts as they are in the bin. Let's just say he a fan of a certain documentary produced by voracious denialists. It's a shame he uses your name to try to give credence to his ludicrous, mistaken and downright dangerous beliefs. In true denialist style, he twists, cherry-picks, misrepresents and takes facts out of context to try to dissuade people from taking meds at all.

At the risk of offending Mr. Strub, I suggest that we collectively handled that poster - and handle those like him - VERY generously, considering the thinly veiled murder they attempt.

We ARE skeptical. Of Orthodoxy, of Big Pharma, of untested treatment, of treatment strategy. Were Mr. Strub to follow our conversations, he would know this. Had Mr Strub followed our history with the banned poster - or even inquired to one of the moderators in private before posting his message here - he might have had some illumination.

If he believes in the dissenter's place at the AIDSMEDS table, perhaps he could loosen the rules of the forum and allow denialist viewponts.

Of course if that happens, I wager most of us who believe in first tiered peer-reviewed science would be outta here (after the ensuing flamewars) - but then again, we are not the target audience for the denialists, are we?

As a LTS, I strongly resent the implication that I or any other poster with treatment experience has in any way downplayed the risks and side effects associated with HAART.

[Sean Strub]

 I specifically pointed out that I don't know anything about the person's posts in other threads, because I didn't want to make a blanket statement about someone's posts.  Butt in terms of his/her posts on this thread I didn't find them inappropriate.

And to jkinatl2, I am sorry you took as personal criticism my suggestion that posters be more generous to those who alert people to risks or are more treatment skeptical.   jkinatl2 is correct, I didn't research the poster's history on other strings, nor did I contact a moderator to inquire about the poster prior to putting up my comment.  If that is expected prior to one posting, then I misunderstand the purpose of this board.  I was simply responding to what the poster had put up on this string.

It is ironic, but I think the denialist movement has actually, in a perverse way, hindered the discussion about treatment side effects rather than expanded it.  There are many different kinds of treatment activism and many treatment activists or advocates or whatever who tend to focus within a narrow area that interests them or where they have expertise, whether it be access, emerging therapies, categories of treatment, side effects or whatever. 

But those who talk a lot about side effects or over-treatment or are seen as "too critical" of treatment as prevention or are otherwise generally a bit more treatment-reluctant than others, have sometimes been maligned or accused or suspected of being against treatment entirely or secret denialists or similar kinds of garbage.  Our community's conversation in that arena is, in my opinion, not as robust as I believe it should be.

In that sense, one could even argue that the denialist movement has served pharma much better than it has served people with HIV.

[bocker3]

Sean,

The twists and turns of this thread have gotten me thinking.........

While I think you are quite correct that folks should be open to listening to other sides in order to learn.  When this particular subject comes up it tends to get heated mainly when individuals who have a history of swooping in to posts only when someone is at a vulnerable space to lay out their orthodoxy -- often with little meaningful personal story or credible information.  Most of the lashing directed at Matt in this thread was based on his history not just his words here.  I understand that you caveated that, but the danger of coming to the defense of one poster in one thread, when there are a number of long standing members who are taking issue with that person is that there is more going on than meets the eye. 

There are few people who will spend the time it takes to get to the place that you or jkinatl2 have gotten as far as HIV knowledge -- and those that might, probably won't get there prior to having to make a treatment decision.  Therefore, while we can provide support, OUR stories and even some links -- the primary players are themselves and their doctors.  Either side getting too strident here will only hinder them in making the decision that they need to make.  There are too many times when we all presume to know what is best for someone else.  Even with knowledge, hell, even with a medical degree, it is the height of presumption -- and down right dangerous, to offer specific medical advice on these forums.  Opinions are fine, but they shouldn't be dressed up as anything else....

It's easy to lose perspective on these forums (I may have done so once or twice.....    ), but I do think if there are multiple people saying the same thing -- one should stop to consider why before jumping into the fray for the person who seems on the outs.

Mike

[newt]

The short answer to the OP's questions, is no you are not in great danger, but considering meds would be timely, especially given your low CD4%. Other matters, posting style, supplements etc, I choose not to comment on.

Good luck with however you choose to go forward.

- matt