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talk turkey with me?
Sep 5, 2003

Dr. Bob,

Do hiv medicines work and for how long does a inital regime last? Only 1 year or more? How long can I live? Please advise. Talk turkey with me, tell it to me straight (as straight as you can is more than enough for me) please.


Response from Dr. Frascino

Hey Mike,

"Talk turkey"? Well, I'm much better with Italian foods. Would a "veal parmigiana chat" or "homemade gnocchi in a calamari red sauce discussion" be okay instead?

Do HIV medications work? Yes, but unfortunately not always. There is no doubt that since the mid-nineties, when more effective anti-HIV medications were introduced, and we learned how to combine them into potent cocktails (HAART= highly active antiretroviral therapy), the death rate from HIV/AIDS has plummeted. The medications are now highly effective in decreasing HIV's ability to replicate. Unfortunately, even though we can frequently knock HIV replication down to "undetectable" levels in the blood, we have not been able to completely eliminate the virus. That means no one has ever been "cured."

So why do I say the anti-HIV medications don't always work? There are 3 primary reasons:

1.Medication side effects and toxicities. A wide variety of unanticipated and definitely undesirable side effects and toxicities related to these medications have become increasingly apparent and problematic as more and more HIVers take these drugs for longer and longer periods of time. Not infrequently, these side effects/toxicities can be so severe that the medication must be changed or stopped.

2.Adherence. Various anti-HIV regimens can have a high pill burden or inconvenient medication requirements for dosing times or food restrictions. In order for these medications to remain effective, nearly perfect adherence is required. That means never (or at least extremely rarely) missing or skipping a dose. This is an incredible challenge considering we must take these drugs essentially for the rest of our lives, especially when many of the drugs can cause fatigue, diarrhea, lipodystrophy, and a wide variety of other very annoying, uncomfortable, and inconvenient symptoms.

3.Resistance. The virus, over time, can, and often does, learn how to become resistant to the medications. The chance of this happening increases when the virus is not suppressed to "undetectable" levels in the blood. The risk of developing resistance increases if the virus is allowed to replicate, as it does, for instance, when doses of anti-HIV medications are skipped or missed.

So, how long does an initial regimen last? That depends on many factors, including:

The strain of virus you have The effectiveness of the medications selected for the initial regimen (Was the virus resistant to one or more of them?) Tolerability (Can you tolerate the medications and their side effects/toxicities over the long haul?) Adherence (Can you adhere strictly to the medication regimen, dosing schedule and food restrictions?)

So, Mike, how long can you live? I don't know. I wish I had a crystal ball that worked, but I don't. I do have an old mirrored disco ball, but I don't think it will be much help. There are several things you can definitely do to increase your odds of dying of old age rather than HIV:

1.Work closely with a competent and compassionate HIV/AIDS specialist. The disco ball says, "Remember the Disco classic, 'I Need A Man'." (Although of course your HIV specialist can be either a man or a woman!)

2.Stay involved in the medical decision making by staying informed (i.e. reading The Body and other reputable HIV information sources) and maximizing your health (not smoking, decreasing stress, maintaining an excellent diet, getting appropriate rest/sleep and exercise, not abusing drugs, etc.) The disco ball says, remember the Village People and "YMCA" --- get out there and exercise!

3.Adhere strictly to your medication regimen. The disco ball says, "Don't rock the boat. Don't rock the boat baby. Don't rock the boat. Don't tip the boat over."

Finally, the disco ball says, "Think about Cher and 'Believe.'" If she can still look great in sequined stretch hip hugger-bellbottoms, stilettos, and a Bob Mackey feathered bra on her World Tour at age 56, well then we should be able to cope with HIV, HIV meds, and all the associated challenges. Don't you think?

Hey, maybe that old disco ball is a crystal ball after all. It's sparkling brilliantly and I think I hear Gloria Gaynor screaming, "I will survive!"

So, Mike, shall we dance? I think Babs and Donna are up next with "No More Tears Enough is Enough".

Stay well.

Dr. Bob

paranoid unprotected sex, checked white blood cells normal
Zerit and Videx Replacement Suggestion?

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