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Author Topic: What to treat first, hiv or OI?  (Read 2942 times)

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Offline kuttakamina

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What to treat first, hiv or OI?
« on: December 10, 2009, 12:45:27 AM »
If you have been diagnosed with classic systemic fungal infection, have multiple food allergies, and are hiv positive, what should you treat first? Or treat all at the same time?

Will just taking ARVs fix the other two problems? If not, then you will continue to have food reactions while on ARVs. Do ARVs have antifungal properties as well that I can take them and not have to take antifungals separately? Most western docs don't even buy into the candidiasis theory. This is very confusing.

Where I am, I can get diflucan tablets without prescription, is it safe to self-medicate?

Only serious and knowledgable responses please

Offline Assurbanipal

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Re: What to treat first, hiv or OI?
« Reply #1 on: December 10, 2009, 03:07:04 AM »
Many doctors have felt that they should first stabilize the patient and then treat the HIV -- other doctors have disagreed and said you should treat for HIV right away. 

There was a study done this past year and it found that patients did much better when the HIV was treated right away, for those suffering from an OI. 

The study is discussed in this thread http://forums.poz.com/index.php?topic=27167.0
it does not appear to be targeted at candidiasis specifically, but rather the more general question of OI's.

The new US treatment guidelines also suggest that it is almost always better to start right away when there is an OI present.  The section of the guidelines addressing this is on pp 29-30 and reads as follows:

Acute opportunistic infections
In patients with opportunistic conditions for which there is no effective therapy (e.g., cryptosporidiosis, microsporidiosis, progressive multifocal leukoencephalopathy) but for which antiretroviral therapy may improve outcomes by improving immune responses, the benefits of antiretroviral therapy outweigh any increased risk, and therefore treatment should be started as soon as possible (AIII).

In the setting of opportunistic infections, such as cryptococcal meningitis or non-tuberculous mycobacterial infections, for which immediate therapy may increase the risk of immune reconstitution inflammatory syndrome (IRIS), a short delay may be warranted before initiating antiretroviral treatment [101-102](CIII).

In the setting of other opportunistic infections, such as Pneumocystis jiroveci pneumonia (PCP), early initiation of antiretroviral therapy is associated with increased survival, and therapy should not be delayed [3] (AI).

In patients with tuberculosis with low CD4+ T-cell counts, initiating antiretroviral therapy within the first 2 months of treatment for tuberculosis appears to confer a significant survival advantage [103-104]. Clinicians should refer to Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents [105] for more detailed discussion on when to initiate antiretroviral therapy in the setting of a specific opportunistic infection.


The above section refers to the Guidelines for Prevention and Treatment of OI's -- they are here http://aidsinfo.nih.gov/contentfiles/Adult_OI_041009.pdf
5/06 VL 1M+, CD4 22, 5% , pneumonia, thrush -- O2 support 2 months, 6/06 +Kaletra/Truvada
9/06 VL 3959 CD4 297 13.5% 12/06 VL <400 CD4 350 15.2% +Pravachol
2007 VL<400, 70, 50 CD4 408-729 16.0% -19.7%
2008 VL UD CD4 468 - 538 16.7% - 24.6% Osteoporosis 11/08 doubled Pravachol, +Calcium/D
02/09 VL 100 CD4 616 23.7% 03/09 VL 130 5/09 VL 100 CD4 540 28.4% +Actonel (osteoporosis) 7/09 VL 130
8/09  new regimen Isentress/Epzicom 9/09 VL UD CD4 621 32.7% 11/09 VL UD CD4 607 26.4% swap Isentress for Prezista/Norvir 12/09 (liver and muscle issues) VL 50
2010 VL UD CD4 573-680 26.1% - 30.9% 12/10 VL 20
2011 VL UD-20 CD4 568-673 24.7%-30.6%
2012 VL UD swap Prezista/Norvir for Reyataz drop statin CD4 768-828 26.7%-30.7%
2014 VL UD - 48
2015 VL 130 Moved to Triumeq

Offline mecch

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  • red pill? or blue pill?
Re: What to treat first, hiv or OI?
« Reply #2 on: December 10, 2009, 04:07:21 AM »
As above, the most recent thinking is to hive HAART when someone has an HIV-related OI.
HAART will be for the long term. Your OI's can be treated by your specialist with the apprpriate medication or lifestyle changes as necessary and as not contraindicated for your HAART combo.
As for systemic candidiasis - you won't find many MDs into this but you miight check out an MD like Dr. Jon Kaiser who developed a "holistic" approach to HIV treatment that includes HAART and other treatments. If that is the way you are leaning, you need to find an HIV specialist who is open to working with other kinds of medicine and health providers. 
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline hotpuppy

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Re: What to treat first, hiv or OI?
« Reply #3 on: December 15, 2009, 10:49:29 PM »
If your dinner is burning on the stove is it more important to open a window or remove the pot from the flame?

I would say both.  You need an immune system to supress OI's..... 
Don't obsess over the wrong things.  Life isn't about your numbers, it isn't about this forum, it isn't about someone's opinion.  It's about getting out there and enjoying it.   I am a person with HIV - not the other way around.

Offline aztecan

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  • 32 years positive, 60 years a pain in the butt
Re: What to treat first, hiv or OI?
« Reply #4 on: December 15, 2009, 11:44:45 PM »
Hey kuttakamina,

You can do both - treat the HIV and the OI. However, I would warn against taking Diflucan without talking to your doctor first.

Some HIV meds don't react well with Diflucan (fluconosole), and the Diflucan is also very hard on the liver.

So, while you can treat both, you should only do so under a doctor's supervision.

Regarding the food allergies, I can identify to some degree. I have food intolerances, which are somewhat different, but the end result is the same.

I have to avoid quite a few foods. But, even though its a pain and may mean you have to do more cooking for yourself, you will feel better. I know I did.


"May your life preach more loudly than your lips."
~ William Ellery Channing (Unitarian Minister)

Offline RapidRod

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Re: What to treat first, hiv or OI?
« Reply #5 on: December 15, 2009, 11:51:22 PM »
I was treated first for Histo then after I got out of the hosiptal they started HAART.


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