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Safety of new meds
Dec 6, 2009

My doctor is not putting me on meds until I reach a CD4 count of 350 cells regardless of CD4 percentage. He cautioned that even the new meds are not side effects free and we still don't know what they could do to the body in the long term. Otherwise any newly diagnosed would be immediately on treatment but the guidelines don't recommend it. I was reading your comments on treatment and they all seems very optimistic. Too optimistic for my doctor since he can't understand why you are so confident that the meds will work for decades without serious side effects. He said that if you have a study to confirm this to post it. I guess you and nobody else is willing to take the responsibility about the chances of developing body changes or organ damages with the new meds. Right?

Response from Dr. Young

Hmmm,

You raise many common concerns; let me try to address your main ones.

First, no one (including me) says that any medication or medication regimen will be 100% tolerated or non-toxic in 100% of individuals. This goes for prescription meds, supplements, herbs, etc.

What we do have is many, many clinical trials that outline the likelihood of toxicity and side effects; when they occur today, most are mild, and when they aren't they are, in general, shown to be better than uncontrolled HIV infection. We also have multiple large scale clinical cohort studies from multiple countries (and ethnic and racial groups) that show that death from HIV and HIV complications is very much reduced when people have access to medications for HIV. In the spirit of evidence-based (rather than faith-based) medical decision making, I'd suggest that your healthcare provider look at the NA-ACCORD, HOPS or EUROSIDA clinical studies. Indeed, it's still clear that while life expectancy is much improved with treatment, there are still many challenges and things to learn.

Lastly, I have many, many patients who have been taking HIV medications successfully since the beginning of the combination treatment era -- in 1995-1996. To assert definitively that the bottom might (or might not) drop tomorrow is speculative -- nevertheless, thousands of patient experiences for over a decade has to count for something, no?

So, for now, I do take the very personal and professional responsibility for all of the hundreds of people who have trusted their medical decision making to our doctor-patient relationship. I find it offensive that you'd accuse me (and many other very hard working care providers) of the contrary.

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