POZ Community Forums
Main Forums => Living With HIV => Topic started by: livingpos on November 02, 2013, 03:30:22 am
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Hi,
I have been positive for 10 years with stable CD4 IN 600 range, satisfactory CD4/Cd8% and a viral load that rollercoasters between 10k and 100k. While I feel fine and my tests are good, I have been reading about how the virus causes inflammation in the body and the damage this inflammation might cause. I have spoken to my doctor about whether it is worth starting meds but he says that besides the logic of helping the body deal with inflammation by reducing the viral load there is no scientific evidence that this is necessary.
Has anyone out there found themselves in a similar situation?
thank you.
Livingpos
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Yeah, I am in a similar position. Poz since 2005/06 (estimated date of infection), and still not on meds. Long term viral inflammation is definitely something to be concerned about, although it holds good that so far no study has conclusively proven a net benefit of commencing therapy with a CD4 higher than 500. Your doctor is right and mine said the same thing. But then many other doctors suggest starting meds asap. It's really up to you and what you feel comfortable with, together with your doctor's advice of course.
The latest WHO guidelines now also recommend starting therapy at a CD4 of 500, as do the DHHS guidelines- but they both say: "There is insufficient evidence and/or favourable risk–benefit profile to support initiating ART at a CD4 cell count >500 cells/mm3"
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Well I can't give any advice on when you should start meds, I don't know what i'd do if I were in your shoes.
I didn't have the option to choose after I was diagnosed, but had to start meds right away, I started getting nerve damage in my feet and hands. My doctor advised that inflammation is one of the key factors that causes neuropathy and nerve damage either sooner or later if not controlled.
He believes my nerve damage didn't start getting better until my VL was UD for quite a while allowing my nerves to 're-connect' from the inflammation damage. Its a lot better, but not back to normal, I will always have some sort of damage that won't fix itself, and I feel it from time to time.
This may never happen to you, i'm just giving my scenario and what was told to me from the doctors.
Plus being UD helps with other folks you may be with to add and extra shield of protection for your partners or future partners if they happen to be negative.
That's just my two cents, It would be nice to not HAVE to take them though, so I understand the dilemma.
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If you're talking about population based studies, I'd say there's no definitive evidence on when to start because people haven't lived long enough yet, but I think having a high viral load worsens cardiovascular risk and probably nerve damage as well. If you keep an UD viral load it's about being healthier in 20-30 years. Granted, medications have side effects as well-- something to consider if you're going to take them for the rest of your life (or until something better comes out;).
Do you think you'd take the regimen reliably? If so, I'd consider taking something. I think there is some wisdom in "an ounce of prevention = a pound of cure."
If I were in your shoes I'd probably start, but as I was diagnosed with AIDS I have a sort of "would-have should-have could-have" perspective.
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This is something I am concerned with, as I count at least 12 years of infection and not on meds. Have I had irreversible damage from holding off meds? I hope not. The issues I think about most are heart and other organ disease, and cancer.
I just read an article about heart attacks and HIV, here on this site. According to the study, HIV poz folks had a greater risk for heart attacks over neg counterparts and especially if CD4 dipped below 200. When they discuss nadir CD4, I assume this means what your CD4 was and basically stayed at, rather than an artificial drop due to illness. I had a drop to 171, but I don't think that applies, when they discuss nadir in studies??
Here's part of their summary and I am confused by the people on meds having a 50% increase. I am awful at studies. Is this due to the meds, or probably having had their CD4 below 500 and possibly less than 200, so they were more likely to be on meds?:
"After controlling for various factors, the researchers found that HIV on the whole was linked to a 44 percent increase in the likelihood of heart attack compared with HIV-negative controls. Those people with HIV who were taking antiretrovirals had a 50 percent increased risk of heart attack when compared with the controls.
Those HIV-positive people with either a current CD4 level below 200 or whose lowest-ever CD4 count dropped below this number had a respective 76 and 74 percent greater likelihood of heart attack when compared with the HIV-negative group. Those who never experienced a CD4 count at or below 500 had no greater risk of heart attack than the control group."
http://www.poz.com/articles/heart_attack_761_24748.shtml
Then, there was this recent article here how hardening of the arteries is linked to HIV infection of 8 or more years, REGARDLESS of treatment history.
http://www.poz.com/articles/atherosclerosis_link_761_24735.shtml