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Strategies to Delay Start of Meds
Jan 2, 2004

I tested positive in September 2002, and couldnt have been positive for more than a year before that, although I could never pinpoint exactly when nor how I got infected. Initially my labs were great, t-cells over 600 and viral load around 20,000. This only degraded a bit for 1 year and then in November everything started crashing: CD4s dropped to 500 in Nov then 444 in Dec, and while my viral load was still 23,000 in Nov now it is almost 50,000. My cd4 has fallen to 27 from 38.

I have several questions if you are willing to answer them:

1) Is it common to degrade so quickly after only a couple years? I thought I might have another year or two. Is this likely to continue to the point that I will need to begin medicines in a couple of months when I reach 350 or can it bounce back? (I am so far asymptomatic). 2) Is there anything I can do to slow the decline? Generally, but especially in the last couple of months Ive cut drinking and have been exercising 5x/week with fewer late nights out. I dont smoke or take drugs. I was super depressed about this but lately Wellbutrin and Androgel seems to be helping. Ive considered joining a monastery but hear they dont take gay men. 3) Seems like most doctors sniff at non-traditional remedies. But Ive read that both Echinacea and Ma Huang are bad for people HIV+, so Ive stopped taking either of those (used to use Ma Huang for workouts). Ive been supplementing with very complete multivitamins (Super Nutrition Mens Blend), but are there other herbs that have been shown to support the immune system? I cant believe that if some herbs are strong enough for doctors to agree they can hurt you, then some must be strong enough to aid immune functions?

I ask this because I would like to stay off meds as long as possible, and Im looking for any strategies that might help. I have a friend HIV+ for over 12 years, he has been doing great but now he is resistant to most meds and has to go on Fuzeon, so I fear for how long HAART will actually work even with adherence (his adherence was great) and want to buy as much time as possible.

Response from Dr. Pierone

Hello, it's hard to predict decline in CD4 cells and changes in viral load. You may actually rebound without any changes and maintain CD4 cells above 350 for years. It sounds like you are doing what you can to stem the decline. Exercise, avoiding toxins (like smoking), taking a complete multivitamin, and a balanced lifestyle are all sound practices.

With regard to herbs, who knows? Maybe an herb will boost immune function and protect against the effects of HIV. Maybe an herb will stimulate the immune system and increase HIV replication as a result of this simulation (remember HIV eats CD4 cells for breakfast, macrophages for lunch, and dendritic cells for dinner). Maybe we want an herb (or treatment) to dampen immune function in order to protect it against HIV.

I think a promising way of bringing the resources of the immune system to bear against HIV may be a therapeutic vaccine, although admittedly, we are years away at the least.



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