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continue with meds?
Jun 30, 2008

I feel I was pressured into started meds by my doctor. My levels had been the same in the 4 years of my hiv positive status and i had not experienced any sickness and had led the same life as before i was diagnosed. I feel I was fine before i started and have always led a healthy life. I exercise, eat healthy, no drugs, dont smoke, etc...I want to know if its a smart decesion to stop my meds, with doctors supervision of course, and see what happens. What is your advice on this subject?

Response from Dr. Frascino

Hi,

No one should feel pressured into beginning treatment for HIV/AIDS. It should be a mutual decision involving both you and your HIV specialist. Certainly there are very good reasons to consider starting HIV medications. A quick look back into the pre-HAART (highly active antiretroviral therapy) era confirms that our current HIV medications have been nothing short of miraculous in decreasing HIV/AIDS morbidity and mortality. That said, there is also no doubt that taking these potent medications is challenging and that side effects/toxicities are common. We continually try to balance the known beneficial aspects of the drugs against the risk of side effects and toxicities in determining the best time to begin treatment. Current treatment guidelines recommend starting treatment when the CD4 count drops to 350. You can read much more about this topic in the archives. Turning back to your question about stopping your medications, the answer would depend on many variables, including your CD4 count nadir, HIV plasma viral load, current medication-induced side effects/toxicities, etc.

I suggest you have a heart-to-heart discussion with your HIV specialist. Be honest and tell him you felt pressured into starting therapy and are considering stopping. If you don't get a satisfactory response from him, consider getting a second opinion from another HIV specialist before considering discontinuing your medications. Results from recent clinical trials have found that STIs (strategic treatment interruptions) are harmful and that those folks in these studies who stayed on their medications fared better.

Good luck.

Dr. Bob


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