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Prognosis For Stating Meds?
Jan 13, 2006

Hi Doctors!

Thanks for your inspirational work and thoughts that keep me going when I read the board.

I have been positive for about 18 months now. I have come to accept it, and after reading many of your responses, plan a full and active life. I feel so "normal" and sometimes have to pinch myself to remember I'm infected. It seems weird at times.

I'm a 33 year-old hetero male. I don't have any substance abuse (apart from tobacco - but ok... I'm working on that one!)I drink socially.

The last 3 labs my viral load has hovered in the 30000-40000 range. My CD4% has stayed the same for all 3 labs at 38%.

However, my CD4 count has gone from 767, then to 660 and then to 580. Is this a cause for concern? My own specialist said "no" as the CD4% being stable is more important, and if I had the blood test the day after I actually had it done, it may have been a totally different number. I don't get this - can you shed any light?

Also, what's in the pipeline for new meds? My doctor seems to think it will be AT LEAST 4 years until I need to start looking at meds (all being well). Do you agree with this? When I start meds in 4 years time, will I be taking the same stuff that's around now, or simply "one pill a day"?

Finally, is it going to be as simple as simply "popping a pill or two" every day, and my life will be the same as if I don't have HIV? I read some horror-stories of side-effects, liver damage and all sorts of horrible things that scare me on this website. "Take your meds every day and you can have a normal or near-normal life expectancy" sounds far to easy to me... what's the catch guys?

Thanks again for all your great work. I live and work in Thailand, and your website is a great resource. Just to let you know - the medical care in this country really is first class.

Sawadtee Khrup!

Response from Dr. Young

Thanks for your post and very meaningful words. It's always great to know that we're reaching an international audience.

I'm with your doctor. (And yes, the Thai medical system is excellent.) If you're asymptomatic, now isn't necessarily the time to start medications. I'd continue to follow the trend in your CD4 counts (both absolute and percentages). The issue here is that CD4 absolute counts vary a lot and percentages tend to vary less-- if your follow your's over time you'll see this behavior.

The pipeline right now is quite full with several new classes of drugs and recently approved improved formulations of older drugs.

I'm reluctant to try to accurately predict the actual timeline for starting a patient's medications, but I do agree that with a normal CD4%, it will be quite a while before you'll need to do so. When you do ultimately need to start, the one-a-day pill will undoubtedly be here (Gilead and BMS announced this week that they have met the formulation issues).

Yes, it can be as simple as taking a few pills, once-daily-- provided that you and your doctor choose appropriate medications for your and that you're able to take them with optimal (near-perfect) adherence. There have been horror stories of tolerability and toxicity- most date to our early, desperate days. Current medications are easy to take, well tolerated and very potent for the vast majority of patients that have access to them. Among our first-line patients, we really haven't had significant issues with toxicity or failure for a very long time. The difficulty comes with patients with multi-drug resistance...

So, good luck, be well and again, thanks for your words. Stay in touch.. BY



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