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Diagnosed in 1991
Dec 21, 2012

52 year old male.. I was diagnosed in 1991 with HIV. Have never been I'll with opportunistic infections, but I have had my share of cardiac issues, with high cholesterol, triglycerides and CAD. Since my cardiac issues began in 1988, my lipid levels and liver functions have been monitored every 6 months. Since being diagnosed with HIV in 1991, my CD4 counts have also been monitored every 6 months. My CD4 counts have ranged steadily between 750-900 every 6 months for the last 22 years. Here's my question, I have never been prescribed any HIV drugs or ART, nor have I taken any for the simple fact that, "if its not broken, don't fix it". I been afraid that with all the other cardiac/hyperlipidemia drugs that I do take, something will be thrown off balance. Your thoughts in treatment versus non treatment? I am closely monitored by both primary care physician and cardiologist, who have agreed with my lack of treatment philosophy.

Response from Dr. McGowan


Your question touches on an area of great current interest. Since you have had cardiac "issues" from a young age (your early 30s), you are at high risk for further heart problems. HIV itself can contribute to an increase in coronary artery disease and early atherosclerosis because it maintains a steady, chronic increase in "Immune activation". This means the body has a higher level of inflammation and this can cause damage to the lining of the blood vessels and build up of cholesterol and fatty plaques (coatings that narrow the inside of the blood vessels and cut down on the flow of blood). The International AIDS Society-USA has listed High Risk for Cardiovascular disease as an indication to begin antiretoviral therapy sooner and regardless of CD4 count. Unfortunately, we do not have good markers of immune activation that we can use and rely on in the clinic. These are research tools. You have been a long-term non-progressor as far as your HIV is concerned. In general long-term non-progessors have a lower state of immune activation than people with lower CD4 counts, but possibly higher than a person on suppressive antiretroviral therapy. Since the time of your diagnosis your doctors have mainatined a balanced approach weighing the pros-and-cons of treatment of your cardiovascular disease. It would be best to include an HIV Specialist in your care team, who can work with you and your other doctors.

Best, Joe

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