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Starting treatment... mixed messages
May 23, 2011

I hear that in 2009 the treatment start date was around 350CD4 T Cells or Below. Now in North America and also here in Australia it's 500CD4 T Cells or Below.

This sound very odd and one has to ask the question ...How many Medical Professionals are getting "kick-backs" from these Drug Companies???

My CD4 T Cells are 420 I'm fit and have no symptoms why should I start medication??? As its a life long commitment.

Many Thanks.

Response from Dr. McGowan

Thanks for your post.

Thoughts on when to start treatment are definitely evolving...toward earlier initiation of treatment. The move to 500 + was supported by trials such as NA-ACCORD which showed a survival advanatge for people who started versus those who deferred treatment to below 500 cells.

While the studies have their limitations, the drive to earlier treatment is really being pushed more by the science of HIV than by any particular clinical trial. We know now that HIV is causing damage to the organs of the body long before a person would have AIDS or have any symptoms. Rcent studies show that people with HIV are at increased risk for heart attack and stroke, kidney and liver disease and memory (cognitive) deficits. This is being linked to the effects that HIV has to create imbalance in the immune system and mainatain a state of constant inflammation (called immune activation) in the body. Most CD4 cells that are killed during HIV infection are not actually infected, they are killed as part of "collateral damage" done as the virus causes immune activation. So, it seems likely, that the sooner you interrupt this process by dampening down the dysfunction of the immune system, the less damage, and the better chances for recovery there may be. So, there is a continuous line from the start of the infection till when AIDS may dvelop (it could take many years), it is now a matter of choice of the individual to decide for themselves when they want to stop that process. Some may want to stop the process by shutting down the virus as soon as possible, others may weigh the balance for a later start...it is an empowering decision.

Best, Joe



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