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starting antirals in end-stage aids
Sep 18, 2002

My husband has been dx'd very recently...after a 2yr hx of weight loss, recurrent oral candida, and recurrent URI's. Finally got him to go to a doc after he became too weak to work (about one month ago).Haven't gotten the results of his viral load back yet, but we are wondering if it's ever too late to start antivirals. He is very debilitated now, has herpes simplex I in his mouth, and can swallow only liquids. Weight con't to drop, very confused, almost no memory, moderately high fevers daily. He is adamant about no hospitalization, but does go the HIV clinic for ivf's for hydration. His doc says that we can try the antivirals if so desired, but that he will get worse before he gets better. What's your opinion?

Response from Dr. Young

It's never too late to start therapy for HIV.

I'm not sure that I understand your doctor's comments-- while it is very reasonable not to force someone to take therapies that are unwelcomed, there is no reason to think that he'll get worse before better. Occasionally, some persons have reactivation of old infections (maybe this is the root of his/her comments), but this is a rare event.

Clearly, it's important to know your husband's CD4 cell count and viral load before passing any judgement.

In general, the response of persons with advanced AIDS to therapy is not quite as good as those with higher CD4 cell counts, but very adequate response do occur frequently. I just saw a patient today who is doing very well with a current CD4 cell count of 340-- 2 years after his initial diagnosis with AIDS wasting and a CD4 cell count of 15.

The real key to success is finding good medical advice, potent and well tolerated medications and lastly to have excellent adherence.

I wish you and your husband much luck for health. -BY



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