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Your guidance please!
Sep 18, 2002

Hi Dr. Young!

"To defeat the enemy is to know about the enemy".

I am reading as many books as I can about HIV/AIDS after knowing that a friend of mine was diagnosed with HIV+. I started with The Guide to Living With HIV Infection: Developed at the Johns Hopkins AIDS Clinic. Then I browsed many Internet websites and found out about this site about 2 months ago...and have been reading the expert's forums ever since. This book gave me an overall picture about HIV and AIDS.

When my firend got tested...her VL was 151,000 copies and her CD4 was 251. Based on the most recent guidelines she would need to start the HIV treatment. Currently, my friend has been on medications for a month now with a combination of Zidovudine and Lamivudine taken twice daily. We will know the effectiveness of the drug when she gets tested in two months.

I was curious to know about the side effects and treatment failure issues...I bought two more books. These are controversial books, I know, but I was curious with what they had to say. I bought What if everything you thought you knew about AIDS was wrong? by Christine Maggiore, and Inventing the AIDS Virus by Peter H. Duesberg.

I started to read the book by Ms. Maggiore...and was horrified with what she wrote. I believe that the author is a chronic non-progressor (the lucky 5 of total HIV+ patients). She wrote to the general audience as if the exception was the rule. She is against taking HIV meds just because these drugs are so toxic..that AZT and other nucleoside analog drugs destroy the kidneys, bone marrow, liver, intestines, muscle tissue, and the central nervous system. What good is it to keep the T cells artificially high while the drugs destroy organs??? Reading the excerpt of the second book...I found out that Mr. Duesberg was making the same claim.

As a health professional...please give me and the others your guidance. Are these two authors just trying to sell books??? Are the drug companies really trying to make as much money as they can by taking advantage scared HIV+ patients???

Thanks for taking the time to answer Dr. Young!

Response from Dr. Young

Thanks for your question.

Firstly- I'd want to be sure that your friend is not only taking zidovudine and lamivudine (2 drug) therapy. Virtually no one would find this a suitable treatment regimen alone, though certainly would be potent components of a 3- or 4-drug regimen. So, I'd ask you to verify that she's on an additional drug. If not, please write back or ask her to ask why.

Side effects of these two drugs are well documented-- lamivudine is among the best tolerated HIV medications, with scant side effects, particularly when combined with other (presumably side effect causing) medications. ZDV on the other hand can cause some side effects with frequency-- usually mild, but sometimes can result in the need to switch medications. Initially, headache, nausea, malaise are common; later, anemia, fatigue and in high doses, muscle injury. All nucleoside medications can (rarely) lead to lactic acidosis, a very serious complication of therapy, though this association is greatest for other medications.

As for the Maggiore and Duesberg books-- it is my strong opinion that the "theories" promoted in the books are patently incorrect (i.e., that HIV does not cause AIDS, or that HIV therapies are without benefit) Indeed, the overinterpretation of these "theories" has led many to discontinue effective medications, or never begin treatments.

One example of this comes from my practice, where several healthy patients who had listened to, and believed the Maggiore book (supported by a so-called education group, HEAL) stopped their HIV therapies. Several months (or a year) later, 3 of these individuals presented with advanced AIDS (CD4 counts <50) and serious AIDS complications (including CMV retinitis and disseminated M avium infection). One individual spent 3 months in hospital recovering (now has with improved CD4 count), another has since died. To what extent the books have promoted this is difficult to prove, only to say that these beliefs, promoted by Maggiore and Duesberg played a role in innappropriate treatment discontinuation.

Indeed, many who have promoted the lack of need for treatment (Maggiore included) likely are long term non-progressors-- yes, these individuals probably do not need to be on treatment at the same time as persons who have more typical HIV infection. To extrapolate from non-progressors to all persons with HIV infection is misleading, and irresponsible. -BY

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