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Starting Meds??
Jun 27, 2002

I recently read a summary study based on 4 reports that showed that the time from infection to symptoms 10 years is 53 which I would assume that 47 are still asymptomatic am I correct? I am 55 and HIV+ for four and one half years and not know CD4 count or viral load. If I could possibly hold off even for a few more years until I notice some synmptom..which at first is usually not life threatening..that could give me a few more years added on to my HAART treatments as I understand that they seem to work up to 10 years. To start meds (with current toxicity) while I fell so well is difficult for me to comprehend. Also, maybe in the next few years there might be some new meds less toxic and more potent. Sincerely

Response from Dr. Pavia

These are good questions, but I think you are coming at the problem with some basic misunderstandings. The average time to AIDS was defined as about 10 years, but no one is average. Some people progress very quickly and will develop AIDS within a year, others barely progress at all and may never need treatment, or at least may not need it for 20 to 30 years. You cannot know what is going on, however, without a viral load and a CD4 count, and without following them. The CD4 count tells you how well your immune system is holding up - the higher the number the better. However, it bounces around enough that you need to check it reasonably frequently so you can be sure of what it is doing. We usually test asymptomatic people who are not on therapy about every 3 months. The viral load is a pretty good predictor of how fast the CD4 count will fall. If your CD4 count is high and your viral load is low, you will likely have a high CD4 count for a long time. Conversely, if the viral load is high (say over 100,000) the CD4 count is going to be falling fairly quickly.

We don't know how long HIV meds will continue to work. Again, the issue is not "averages" it is how long they work in an individual. Some have no side effects and seem to maintain perfect control for as long as we have followed them. Others cannot tolerate meds, or more importantly, don't take them religiously, and resistance develops and the benefits are limited.

Likewise, long term and short term side effects are variable. The pendulum has swung too far and while we once did not know there were long term toxicities, there is often and incorrect buzz now that the drugs are too toxic for everyone. Neither is true. In fact, a lot may depend on luck, your genes and other issues. You may have no problems with the drugs over many years, you may have bad problems from the get go, but most likely you will have some moderate and manageable issues that can be worked through.

Not everyone needs to start therapy. The general recommendations target a CD4 count of 300-350 as a good time to start. That is not written on stone tablets, and if you are very reluctant, you can wait a bit longer. Waiting until you have symptoms might be too late, since sometimes the first symptom is a bad opportunistic infection.

Bottom line. Get in and establish a relationship with a provider. Get your CD4 and viral load tested. There are other good reasons to have a provider, and a lot more to good health care than antiviral drugs.

Good luck


enlarged nodes in 4 yr old
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