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Just Diagosed sems like have to start meds
May 16, 2009

Dear Doctor, My father just got diagnosed with HIV (He is 57 years old now). he calculates that the infection would have been caused to him about 2.5 years ago. He is coinfected with Hepatitis B. HEP b he got about 5 years ago and was treated by meds. in December 2008 he had a cd 4 count of 222 and a viral load of 250,000. I wanted to know what meds should he start on? What is the life he can expect and how long? Nobody knows in my family not even my mother. They are not sexually active so at this point of time it doesnt seem neccessry to tell her. Please advise what course of action should be taken. Also he has had a serious bout of scabies which has lasted him a month and was treated with hard core antibiotics. Does this mean that he has reached the symphomatic stage ( Even though the doc who checked him said, lymph nodes have not swollen yet)...would be very grateful if you could answer this query.

Response from Dr. Young

Hello and thank you for your post.

So sorry to hear about your father. He represents part of the changing face of the US and Western European HIV epidemics, namely those diagnosed at a not-so-young age. Indeed, in the US, over 1/3rd of new cases are now among those old folks (like me), over 40; 10% are over 50. There is a increasing appreciation of the special needs of the medical management of older patients with HIV- both those recently diagnosed and those surviving into older age because of advances in medical therapies.

An important aspect of care is the issue of other medical conditions-- such as your dad's hepatitis B. Was this successfully treated (namely, is his virus load undectable and has he protective antibody levels)? If not, and if he does not have significant kidney disease, then a regimen that includes tenofovir and either FTC or 3TC would be strongly recommended, since these two medications treat both hepatitis B and HIV.

With his current CD4 count, high viral load and em, age, I'd definitely recommend that he consider starting on HIV medications (even though he does not meet the criteria for AIDS--scabies doesn't count). It's important to know if he has acquired drug resistant HIV, since this could significantly restrict treatment options. If he does not have drug resistance, then we'd usually start HBV-coinfected persons on tenofovir+FTC (Truvada) with either efavirenz (this makes the co-formulated medicine Atripla) or one of the boosted protease inhibitors- in alphabetical order, atazanavir (Reyataz), darunavir (Prezista), fosamprenavir (Lexiva, Telzir) or lopinavir (Kaletra).

Assuming that he's willing and able to be adherent to the drug regimen, I'd expect him to fully suppress his virus(es) and increase the health of his immune system. Indeed, as I've said on these pages before, I'd expect him to potentially live a normal life expectancy.

Lastly, while it's not critical that your mother know about your father's HIV status immediately, it is probably a reasonable thing to consider the best time and place to inform her-- for the very least, I'd still recommend HIV testing for her (just to be sure).

I hope this helps and wish your father the very best of health.

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