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Newly Positive - A Few Questions
Feb 9, 2005

Hi There.

I am a westerner living in Thailand, and my girlfriend and I both recently tested positive to HIV. After getting over the initial shock, we are settling down now, and after reading your forum we plan on a long and happy life together.

We have one of Thailand's leading HIV/AIDS experts (Harvard educated) looking after us and we are in good hands.

I do, however, have a few questions you might be able to help me with if you can:

1) Is it true that if we have access and funds for medication (which we do) we can expect to live a long, and relatively normal lifespan? Can we REALLY expect to live another 40 years from now?

2) I have a CD4 count of 761 with a V/L of 114,000 (the high V/L the doctor says is probably due to the fact that I had a slight cold when I took my first lab), and my girlfriend is 630 with a viral load of 6,500. The specialist says that it would probably be 3-4 years (maybe even 5 or 6) before I need medication, and maybe a year or two less for my girlfriend. Would this seem right to you? 5 years without medication would be fantastic and almost too good to be true!

3) If it is a few years until we have to start meds, do you think that by that time there will be new drugs available, and they will be more effective and easier to take?

4) Living in Thailand, a big risk here is dengue fever. If I was to catch it at this stage, would it "finish me off", or is my immune system in a good enough condition at the moment to cope with it? (This is one of my big worries to be honest).

5) My girlfriend is petrified about facial wasting - are the medications used for treating HIV effective at stopping this?

6) Finally, what is the average rate that CD4 cells fall by in a year? Is it 80-100, or is there a chance they could plummet by 300 or more in a year?

Many thanks for your time, and thankyou for a wonderful site which has given us some hope.

Response from Dr. Young

Thank you for your post and kind comments. Sorry to hear about your recent diagnoses, but sounds like you have access to good health care in Thailand (one of the bright stars in the international HIV scene).

Let's see if I can answer your questions...

1) Yes, I do believe that you should be able to live well for many, many years. You didn't mention your current ages, but I'll speculate that 40 years isn't farfetched, provided that your not already old (like me).

2)Different people, even with the same virus can have widely different viral loads. That said, yes, having even a minor cold can increase viral loads by a factor of 2 or more. I do agree with your HIV specialist that it will probably be some number of years before either you or your girlfriend will require medications to treat HIV.

3) Yes, there will no doubt be new medications in the next several years and moreover, better insight in how best to use the medications that we currently have, a better understanding of the short- and long-term toxicities and long-term benefits of medications. Many of the anticipated advances are focused on strategies to make medications easier to take.

4) While I don't wish dengue on anyone (it's a really tough flu-like syndrome). I'm not personally aware of information that says that persons with HIV and normal CD4 cell counts are at any increased risk of dengue complications (such as hemorrhagic fever).

5)Facial wasting (lipoatrophy) is a pretty common and unfortunate complication of long-standing HIV, particularly among those persons who received long-term, high-dose d4T (and perhaps to AZT). In my book, the best way to avoid lipoatrophy is to avoid the use of d4T and whenever possible to not wait until CD4 counts are very low to start on treatment (since low CD4 nadir counts are associated with increase risk of lipo).

6)The average rate of CD4 cell decline varies from person to person and is related inversely to the viral load. Persons with higher viral loads tend to have greater annual decreases in CD4s. The typical CD4 cell decline (in the mythical "average" patient) ranges from 50-100 cells per year; it' generally unlikely to see a 300 cell decrease in one year.

I hope this helps-- write back from time to time and let us know how you're doing. Good luck and enjoy some really good Thai food for me. BY



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