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What's happening now?
Jan 13, 2008

Dr Bob,

I was diagnosed last year, and started treatment six months ago. I'm undetectable now, and my CD4 (abs and %) continues to climb.

I'm on: Sustiva or Isestress (trial, so one is a placebo) and Truvada

I'm having absolutely no side effects from these meds.

I'm on a strict diet and have managed to maintain excellent lipid panels (trigs=153, ldl=99, hdl=36)

ALL of my chemistry is in the green!

So, this might be a silly question, but what does this mean is happening inside my body as compared to someone that is negative? I understand I'm not cured, as if I stopped treatment the replication would start all over again; but does even a minimual undetectable amount of viral load mean that my body is using up resources to "fight"?

I understand my thymus has taken a substantial "hit" with the initial die off of CD4 cells, and it will take some time to repopulate those stores, which means that there is a potential to "burn up" my tymus tissues faster as compared to someone that didn't have such stress.

I'm assuming there is also long term effects of processing the medications and their byproducts through my liver and kidneys, so I'll need to closely monitor those organs with quarterly blood analysis.

So as long as I stay undetectable and my body processes the medications well, then would it be fair to say that the best corillary is that it's as though I'm aging just a bit faster than someone my own age now that's negative?

Said another way, as we get older our risks for "general wear and tear" increases, but with diet, exercise, and proper healthcare those risks can be decreased; so if I think of myself as aging a little bit faster, then that means that I have to be a bit more agressive in that management.

Is that an OK way to think of it, or am I missing something fundamental?

Response from Dr. Frascino

Hi,

"What's happening now?" Well, from the information you provided, it appears that your current HIV regimen is working well, both virologically speaking (viral load now undetectable) and immunologically speaking (absolutely CD4 count and percentage increasing). That's excellent news! In addition you are tolerating your regimen with "absolutely no side effects" and your routine laboratory studies are in the normal range more excellent news! It's difficult, however, to compare what's happening inside your body to that of someone who is not infected. HIV infection, even with undetectable viral loads, is a chronic infection with which your immune system continues to do battle. Can this be compared to a "faster aging" process? No, not really. We really can't compare it to anything. The pandemic is only 26 years old and the treatment of HIV/AIDS has continued to evolve at a steady pace. Consequently we really don't know what the long-term morbidity for those of us who are "virally enhanced" will be. Recent reports indicate we may expect increased problems with osteoporosis and other bone-related disorders, as well as an increased incidence of some malignancies and heart conditions. I guess we'll all find out together as we continue to travel this road together. For now, let's remain hopeful and optimistic that we'll all leave this amazing existence from old age rather than old AIDS, OK?

Dr. Bob



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