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future
Jun 29, 2012

hi doc joseph i am positive guy from india and have been taking meds since last couple of years. i have always thought of life where i can make plans, earn money and have kids, and this digonisis has left me devasted, luckily enough i found a girl, who inspite of being negitive wants to marry me. i have a few questions. 1.is this true that hiv positive have near normal life expectancy, as stated in many reports, or real world is different, i read daily about people developing cancers, heart issues, insulin resistance, is there any thing i can actually do about it. 2.is it a sane decision to marry a negitive girl, i mean being undetecable,will it make her safe, also will it be okay if we practice unsafe sex. 3. can i father a healthy hiv negitive child. 4.does life expectancy depends on nadir cd 4 cells, mine were 316, 14 percent, no symptoms. 5.will it be possible to have some sort of functional cure in near future, since all experts say different things, i read some gene therapy things going on, but in other report i read it wont be available before 15 years, theres another one sayng 5-10 years, every thing will chnage, where actually we heading.

Response from Dr. McGowan

Thank you for your questions, and congratulations on your finding a great partner.

let me try to address your points: 1) Yes, life expectancy..in the real world...is indeed getting better. Especially if you can maintain your CD4 count above 500, the rates of many of the conditions you mention..cancer, liver disease, heart disease..seem to go down to normal expected ranges after about 5 years. People who started treatments at lower CD4 counts may remain at some increased risk if their immune system continues to be out of balance, even with an undetectable viral load.

2) Having an undetectable viral load in teh blood definitely lowers your risk of transmitting HIV to your sexual partner. Recent studies show that transmission from an HIV-positive person to their uninfected partner could be reduced by 96% by taking meds. However, some studies show that you may still periodically (maybe 6% of the time) have detectable virus in the semen and genital secretions. So, there may be some risk. Using condoms would be best, it is something that you would need to discuss with your partner.

3) Yes, you can father a healthy HIV negative kid. The virus would have to pass from the mother to the baby, so if your partner remains HIV uninfected your baby would not be at risk from HIV from you. In other words, the virus cannot pass directly from your semen to the baby. Ways to decrease the transmission risk would be to maintain your viral load undetectable, look into artificial insemination/sperm washing if available, timing intercourse to ovulation, and perhaps, having your partner take medicine as part of a "pre-exposure" prophylaxis around the time of the insemination.

4) No direct studies have linked life expectancy to nadir CD$, but, as mentioned, getting the CD4 count up to around 500 or better helps improve life expectancy. A person has a better chance of reaching that goal if they start meds at a higher number...316 is much better than average starting level (in the US it is still at 182).

5) We are in a very exciting time. The goal now, and the theme of the major scientific meetings (for the first time) is "Getting to a Cure". It is likely that genetically focused treatments are going to be a part of this since the meds work so well to shut the virus down, what we are left with is rousting out the virus genes hidden inside some of the CD4 cells. I am very hopeful that great progress will be made in the next few years. As with any therapy directed toward our genes, long-term study for safety will have to be a part of it.

Best, Joe



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