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Update, AIDS in 20 years regardless of meds?
Oct 21, 2005

Thanks Dr. Pierone for your response to my question regarding my HIV specialist's statement, "I will get AIDS regardless of medication or not in 20 to 30 years." After reading your response and talking with a few HIV positive friends in the San Francisco medical community, who I might add voiced their concern to find another HIV specialist in my San Luis Obispo area preferably one who takes a more optimistic approach to fighting HIV, I gained the confidence to call the AIDS Support Network in San Luis Opispo, CA.

To my dismay I spoke with a Physicians Assistant who, at 1st recommended me to see a respected HIV specialist in the area - the same one that I had already seen. After telling the PA counselor what I was told from this physician, he backed her %100, saying, Yes, I'm sorry, but it is true, you will get AIDS in 20 to 30 years. Quite frankly I don't know who else to refer you to because most of our HIV specialist came from same medical school and are highly respected here - you're in good hands.

I felt so energized, so strong, filled with high hopes after reading your response Dr. Pierone, but it all came crashing down when I was once again told that I would get AIDS in 20 to 30 years, to what my friends in San Francisco call, "uncommon practice" or "unheard of" where they're from. Well, yeah, maybe in their big "choose from a hundred HIV specialist city", but obviously not a luxury that I have in San Luis Obispo. Not after that phone call any way.

I'm 22, I'm new to this and I'm scared Dr. Pierone. My friends in SF posed a simple question, "If you had Diabetes and had your diabetes specialist say, in about 20 to 30 years you won't have limbs, would you continue to see that specialist?". Of course not I told them. That's why I called the Network to see if anyone else was out there and all I got was someone reiterating what my pessimistic Doctor said in the 1st place.

There is no doubt in my mind that this physician is an excellent Doctor. It would not be fair to question the kind of medical education background they have. All I want is someone who believes in me, believes in my quality of life, that I would someday smile because I'm healthy and not popping pills only to look forward to AIDS. That's not forward. To me that's backwards. And I need advise Dr. Pierone. I need advise as to what steps I need to take in my small town community. Do I drive 4 hours north to San Francisco or 4 hours south to LA for decent medical care? I don't know what to do.

My original question was sent to you and another board member on this Website. You responded with hope. He responded with, "I cannot comment on this matter". The more I learn about HIV/AIDS the more I am learning what kind of people are out there.

I look forward to your response. Thank you

Response from Dr. Pierone

Hello again and I appreciate your follow up. I firmly stand by my original post HIV progression to AIDS is preventable using current biomedical technology. I will admit that is possible that all of our HIV research efforts over the next 20 to 30 years will utterly fail and we will have to rely only on what we have now. This means that we would have no safer agents in existing classes, no integrase inhibitors, no attachment inhibitors, no maturation inhibitors, and no tat inhibitors - nada. Moreover, the therapeutic vaccines might not pan it, gene therapy could be unsuccessful, and siRNA might bomb. This could happen no HIV advances for the next 25 years and pessimism abounds. Gee, your doctor was right after all. But let's get real.

I don't drive the same car that I did 20 years ago. Actually, I drive a Hybrid that gets twice the gas mileage of the car that I drove last year it simply is a better car and came about directly from directed and purposeful scientific and technical efforts. We don't prescribe the same HIV regimens that we did 5 years ago we have better agents as a result of scientific and technical improvements. 5 years from now it will better still.

But to answer your question should you drive 8 hours round trip for medical care? Not necessarily. I know doctors who are pessimistic human beings, but they provide up to date, technically proficient medical care to their patients. I also know surgeons that really don't care for people that much at all, but are outstanding when it comes to operating and taking out diseased gallbladders.

A physician could embrace a certain (erroneous) viewpoint now HIV will eventually lead to AIDS in 20 to 30 years but they could change their mind in the future. Mea culpa - in the early 1990s when I gave lectures on HIV/AIDS I remember saying "that even if we discovered the "magic bullet" for HIV infection that our patients with AIDS would still continue to die because their immune system was already destroyed." Well, with the advent of protease inhibitors and combination therapy, my opinion was decisively proven wrong - patients with AIDS can and do reconstitute the immune system after HAART. So it is not just me, I have seen medical colleagues change long-held opinions instantaneously as a result of exposure to a new information.

The decision to see a doctor/practitioner is based on many factors. If the clinician is competent and caring, this may be sufficient. You don't have to agree on every point. Plus, 10 years from now you could always say, remember that really dumb statement you made to me when we first met about HIV always leads to AIDS? In the modern (internet era) it is possible to get a second opinion without driving 8 hours. I hope that this information helps and best of luck to you!



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