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For the valuable advice
Sep 18, 2003

Thanks for answering my question (from medical student) I showed your answer to my proffessor who previously had argued for cornell being the bench mark life expectancy and he (after much thought) agreed that life expectancy could well be normal- he also said you guys at the Body are doing wonderful things in terms of publishing info on HIV and bringing advice into the public arena- so a very big thanks. I just would like to ask one more simple question do you think that viral resistance means that HIV medicine will be made redundant or will we continue to develop drugs that will compenstate for viral resistance- do you have any opinion personal or otherwise about the lenghth of time (on average) it takes for a patient to exhuast all treatment options - or does perfect adherence change this equation.

Thanks for your encouragement if we can become doctors of the calibre of the generation that has preceded us then maybe we will be on the track to elimate this disease and not just for the developed world but for the millions suffering globally.

Thanks for your inspiration and your help- it is appreciated.

Response from Dr. Pierone

Hello, thanks for your kind words.

The question about life expectancy comes up a lot. It is really one of the first questions that someone newly diagnosed with HIV wants to know the answer to. As we have discussed, I am convinced that someone with HIV infection can live a normal or very close to normal life span. But there are some preconditions. The main one is to possess the personal and social skills to navigate the medical care system and fully adhere to treatment during the time that it is necessary (we still aren't sure exactly when at which point it is necessary to treat and when we can simply observe).

It goes beyond simple adherence to medications though. If and when things don't go well with treatment, one must have the ability to be assertive and work with your doctor to look for other options. It is uncommon that someone must suffer with HIV-medication-related side effects, generally there are other choices. It is not unusual to hear someone say "my doctor told me to just put up with the side effects, because the medication is working." Hello there are lots of medications that work for HIV, how about finding the combination that works but doesn't make you sick. It's not just HIV professionals that make this mistake. Some people with HIV infection are so terrified of changing a cocktail that has their virus undetectable that they insist on staying on obsolete and toxic regimens that are clearly damaging them. Some have seen friends go through a series of treatment changes and subsequently die, so they falsely link in their subconscious that changing medications leads to treatment failure and death.

Having said this, I realize that there are many cases, mostly for individuals with multi-drug resistant virus, in which there is no way around some side effects. But even in this situation there are many times alternatives that may improve quality of life.

But this wasn't your question. I think we must and will continue to develop medications that have activity against drug-resistant virus. More and more people have this problem and need new treatment options. This means that we need new viral targets and progress is being made. Integrase inhibitors and CCR-5 attachment inhibitors are now in clinical trials and more innovative therapies are in the pipeline.

The time course to development of resistance depends on level of adherence and how susceptible a particular regimen is for development of resistance. I think that emerging cocktails will be hardier and less prone to development of resistance and if so, it makes future predictions difficult.



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