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Recently detected - Can ART be delayed
Feb 9, 2013

Hello,

I am 26 years old and I have recently been detected with HIV-Positive. My CD4 count is 642 and I do not know my viral load. It has been 2 weeks that I have been detected.

I have started of with Yoga and Meditation to ensure that my mental health is intact and also I make myself physically healthy. I do Yoga for an hour and 20mins of meditation everyday.

I avoid junk food, given up on smoking (Occasionally smoke 4-5 smokes in a week), I am avoiding alcohol too and I sleep for about 8-10 hours everyday.

I want to know if I continue this lifestyle, what is the possibility of CD4 levels being maintained/increased thereby delaying the start of anti-retroviral therapy?

Response from Mr. Vergel

I am going to be completely frank with you. I hope people read this email since it may get me some criticism from some who may think this is part of the pharmaceutical agenda.

I believe everyone who finds out they have HIV should go on treatment right away, no matter what their numbers (CD4 cell counts and HIV viral load) are and how healthy is their lifestyle. Of course, some people do not have easy access to HIV medications or are not mentally ready to start unless their CD4 counts drop to under 500 cells/mls.

The majority of members of the current DHHS HIV treatment guidelines panel have the expert opinion that treatment should be recommended to all HIV+ patients regardless of CD4 counts.

People who start HIV treatment early may:

1- Have greater normalization of immune function 2- Have greater CD4 gains 3- Have the possibility to have less populated reservoirs of hidden virus. 4- Have less immune activation and inflammation 5- Have a life expectancy that may be close to that of HIV negative people of similar risk factors 6- Have greater chances to be the first ones cured of HIV if we find a cure that may be limited to those with smaller reservoirs (this is a little speculative but some limited data is emerging on this issue). 7- Have lower chances to infect others in case of condom malfunction

Another factor to add is that first line regimens like Stribld, Complera, Isentress+Truvada and boosted Reyataz+ Truvada are well tolerated in most patients. We may have others approved in the future (3-4 years) for treatment naive people that will be dosed one a month.

From emails I get, I know some people with high CD4 cell counts and low viral load want to find out if they will be part of the elite controller group that does not require HIV treatment for many years. The fact is that this group is comprised of less than 10 percent of HIV positive people. We are starting to see data that even these elite controllers have immune activation and increased inflammatory markers that show the constant battle between their immune system and the virus. The interesting thing is that I only know 2 elite controllers. They both smoke and are not followers of a "healthy lifestyle"

Having said that, a healthy lifestyle is important for anyone on or off therapy and may contribute to lower risk of mortality and health issues.

At the end of the day, it is really up to you to know if you are ready to commit to a lifetime of daily meds. The peace of mind that the items I listed can help achieve may be bigger than the fear of side effects.

Let me know if you need any more information.

Nelson



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