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Early Meds guy's question
Dec 23, 2009

Hi Dr. McGowan,

The guy who posted the following sounds like a long-term nonprogressor based on his description of his high CD4 and VL after so many years. In fact, he'd be considered a viremic controller by both the NIH study team (Dr. Stephen Migueles in Bethesda) and Dr Walker's study at Partners in Boston. As an alternative to starting on medication if he's not having any HIV related problems, you could recommend that he look into those studies. People like him are rare and their participation in those studies, where the participant merely donates some blood, is of major importance. I strongly encourage you to point people in that direction when they present a LTNP status, whether it's elite (VL<50) or viremic (VL<1500-2000) consistently w/o meds.

Sincerely, Shawn PS I am a participant in both the studies I mentioned, and viremic controller, HIV+ for just over 5 years. Each study only indicates LTNP as someone maintaining the low VL and normal CD4 w/o meds for a period of 1 to 2 years at minimum, not the much longer time frames that I often see mentioned here.

Referring to: Early Meds? Nov 29, 2009

My doctor said I could start meds if I want; any opinions on starting meds "early"? My CD4 is 598 (it was 607 in May, 653 in '08) and VL is 1254 (it was <75 in May, >75 in '08) and my CD4/CD8 ratio is 36%/46%=.78 (it was .86 in May, 1.2 in '08). My virus genome only shows resistance to AZT. I've enjoyed 8 years poz, free of meds or any related disease (besides some depression). I wonder if potential long-term benefits of meds are greater than the ease of not having to take them now. If no recommendation is apparent, what kinds of questions should I be asking my doctor in order to make this decision? Thank you!

Response from Dr. McGowan

Shawn,

Thank you for pointing out these very important studies. It is essential that we have interested people enroll in these cohorts so that we can learn about how HIV affects the body over time and can offer advice that is based on facts and not opinion.

Best,

Joe



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