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Author Topic: When do you start Meds?  (Read 4855 times)

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Offline sftrek

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  • Posts: 3
When do you start Meds?
« on: July 01, 2006, 08:53:29 PM »
I have been sick for almost 2 weeks (flu symptoms, sore throat, rash, night sweats etc). My doctor tested me for HIV, and the test was negative.  I was out of town for the next 2 weeks traveling where I am originally from, and my doctor from there felt I was potentially sero-converting.  He ran the additional DNA test and discovered that I am right in the middle of converting (5 out of 10 antibodies converted).  My T-Cells are 717 and my viral load isn't back yet.

My doctor wants to put me on Truvada and Kaletra now as an aggressive therapy while I'm currently converting.  My other friends all of have said that their doctors hold on the start of meds as long as possible.

What are the pros and cons of this?  I don't want to start too quickly, especially when my T-Cells are high and then find out my body stops reacting the cocktail above.

I also need a recommendation of a good HIV doctor in San Francisco.

Please help me clarify this.

Offline J220

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Re: When do you start Meds?
« Reply #1 on: July 03, 2006, 01:58:44 PM »
There is an ongoing debate over the benefits of hitting the infection early on. The hypothesis is that by attacking the infection now you would salvage more of your immune system. The cons, of course is that you are starting therapy very early and the issue if resistance can arise sooner, in theory. I think there is a clinical trial taking place that is seeking to answer these questions, you might want to look it up at clinicaltrials.gov. Having said all this, personally, I would have decided to start therapy immediately. With all the options out there I would think that resistance issues could successfully be dealt with, especially when a new class of drug has recently been announced, that could be available in the next few years. Nevertheless, it is a tough decision.
« Last Edit: July 03, 2006, 02:25:11 PM by J220 »
"Hope is my philosophy
Just needs days in which to be
Love of Life means hope for me
Born on a New Day" - John David

Offline sftrek

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Re: When do you start Meds?
« Reply #2 on: July 03, 2006, 02:16:28 PM »
Thanks for your reply.  I am researching the clinical trials as well.

Offline newt

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  • the one and original newt
Re: When do you start Meds?
« Reply #3 on: July 03, 2006, 04:04:58 PM »
Sorry I am lost by the 5 out of 10, did your doc do a p24 antigen test?
"The object is to be a well patient, not a good patient"

Offline elena

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Re: When do you start Meds?
« Reply #4 on: July 06, 2006, 07:38:54 PM »
I'm hiv+ since 1993-as I know...I started to go to doctors 1996.,then my cd4 was 770 and they didn't give me meds.One year later I had pneumonia and my cd4 was 352,then I started with meds.So,I'm on them almost 10 years,results of cd4 and pcr tests were ok(cd4 between 900 and 1000,pcr 0 ).Few times I made pause with meds-about 6 months.The less cd4 I had was about 210 but in this period I had problems with drugs :-\.Now I'm clean,on meds again-videx,stocrin(efavirenz)and epivir.Before them I took videx,viracept and zerit.I don't know why they changed my therapy even cd4 test result was ok ??? I feel ok but I didn't do cd4 and pcr tests almost 1 year-there is big problem with lab tests in my country...
Btw,sorry if my english isn't good,I don't use it often.But I hope you'll understand me  :-[
~ Homo sum:humani nihil a me alienum puto ~

Offline mmuscle

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Re: When do you start Meds?
« Reply #5 on: July 07, 2006, 11:04:53 PM »
Mine is a very similar question.  I just tested positive last Tuesday and received my first set of results today.  My case manager (RN) recommends waiting on meds until I need them.  Another doctor suggested I start on Travada and Sustiva right away.

It appears most recommendations are to wait on the drugs, but there's limited evidence showing there may be some benefit if I start immediately after infection.  There's a UCSF study called Options testing this theory.

What are the arguments for not starting now?  Suggestions?

Offline Robert

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Re: When do you start Meds?
« Reply #6 on: July 08, 2006, 12:31:25 AM »
The basic argument for not starting now has to do with the side effects.  The drugs are  toxic and can have some negative side effects like severe depression. Also HAART has only been in use for 10 years so there are no long term studies on the long-term effects. 

If you GO HERE , you'll find from the archived files a discussion we had on this just this past spring.

« Last Edit: July 08, 2006, 12:34:31 AM by Robert »

Offline newt

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  • the one and original newt
Re: When do you start Meds?
« Reply #7 on: July 08, 2006, 09:34:52 AM »
The argument in favour of meds straight away is an unproven but plausible theory that early treatment preserves the body's ability to deal with the virus.  However, there is no study yet published which says, strongly,  yes or no in answer to this question. 

Furthermore, while Sustiva/Truvada is a very popular and effective option, it is not the only option. There are good reasons to go with a modern PI based combo rather than an NNRTI like Sustiva), including (A) the absence of mental head-screwing side-effects which affect many (but not all) people on Sustiva (B) the mysterious immunological properties of PIs (boost your CD4 often then seem too) (C) risk of side effects on NNRTIs looking like being higher if your CD4 count is higher (Viramune is the main culprit here but it is also true to a lesser extent of Sustiva) (D) easier to stop a PI combo than an NNRTI without the risk of resistance, thus preserving this class of drug for the future (there is a good and bad way to stop).  Short version: if you do decide to do treatment now, which is a fair either way call, look at the options for a combo and choose one that fits your life rather than the doc's preference.

- matt
"The object is to be a well patient, not a good patient"


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