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How long to go ? Again !
Nov 1, 2003

Hello Gerald,

In response to a question "How long to go ?" posted a week or so back a recently diagnosed HIV+ individual asked you about life expectancy. I've read your reply over and over again !! As a kind of therapy ! You state that "providing that the patient has access to antiretroviral therapy, and is adherent, they can expect a normal, or near normal life expectancy".

I have just been tested positive and so forgive me for trying to cling to anything on that gives me hope. Do your comments reflect an accurate assessment of where we are at with HIV today ? More chicken soup for the soul required.Please !!!

Best wishes, and thank you for your work.

Response from Dr. Pierone

Life expectancy is one of the aspects of HIV medicine that is most misunderstood. I still meet people that don't realize that HIV and AIDS are no longer considered a uniformly fatal disease. The reality is that even people with AIDS and a profoundly depressed immune function can recover and live a normal or near normal lifespan. This is by no means a guarantee, and many people simply can't pull off what it takes to survive AIDS.

There are some basic skills that are needed to survive (and thrive) with HIV. An important element it to find a competent HIV treating doctor, nurse practitioner, or physicians assistant. This should be someone that you like and trust. If the prospect of visiting your doctor gives you chest pain it may be time for a change.

The single most important thing is that one really must want to live. This may sound obvious, but for many people it is not that simple. I have seen once vibrant people give up completely and just let the disease take its course. This usually occurs when people are overwhelmed and depressed and just don't have the resilience to deal with the system to get mental health care and medical care. Some people have substance abuse issues and their energy and efforts are expended in getting high and this often precludes taking medications regularly. Some people just don't feel worthy to live because the slings and arrows from a hard life have left them wounded and damaged. Tapping into some higher purpose or reframing one's life mission can transform people and give them the gumption to survive just about anything.

For those that are already there, love life, and want to stick around for a very long time it can be done. The most important rule: when it is time to start medications, don't screw it up. Don't miss any scheduled doses. If the medication makes you sick let your doctor know so a different regimen can be prescribed. Stay informed about advances in therapy and if things aren't going well be sure to get a second opinion.

Even those that have had challenges with adherence in the past and have multi-drug resistant virus can do extremely well. Especially with some of the new agents in the pipeline things are looking up.

Best of luck!

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