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Jan 7, 2014

Dr. Young

Once again, thanks answering all my questions over the past 10 years.

I was diagnosed with HIV over 10 years ago and have been a long term non-progressor with a VL most undetectible and Tcells between 900 - 1300 over the past 10 years. I have never taken meds. Now that I am 50, what are your thoughts on taking meds if my numbers remain the same. Is there a benefit not to taking the meds. I really dont want to take meds if it is not necessary.

Response from Dr. Young

Hello and Happy New Year to you.

I'm very happy to have been able to help with your questions for so many years.

To begin, it's important to bear in mind that recommendations for ART for long-term non-progressors (people with very low or undetectable viral loads off treatment) are generally different than those for the general HIV+ population.

Antiretroviral therapy (ART) is recommended for most persons living with HIV here in the US, and for those with CD4s <500 in the rest of the world (by World Health Organization recommendations), ART is also recommended for all persons over the age of 50. It's less clear how long-term non-progressors like you should be treated (or not). At first glance, you've held off HIV's main injury- namely keeping your CD4 levels in the healthy range. Ten years without decline in CD4s suggests to me that you may not require ART (at least for now).

A new area of concern about HIV is the notion of immune activation and elevated inflammation. As such, it might be reasonable to look at whether HIV, even in the absence of measurable virus in your blood, might be causing elevation in markers of inflammation (such as ESR or CRP). If not, this would give further support to continuing to hold off on ART. On the other hand, if these markers are elevated, then this might suggest the potential for health risks, and point towards using ART.

Stepping aside the question of ART, then it's very reasonable to be aware of the myriad of issues that people living with HIV may be at greater risk- such as cardiovascular, kidney, bone or liver disease, cognitive problems or cancers. I'd take a very aggressive stance on screening for these issues and looking for ways to decrease the risk of these complications (whether caused by HIV or other factors). At a minimum, this means looking at cardiovascular risk, kidney health, bone density scanning, getting screened for cognitive and mental health, colonoscopy and so on. When necessary, getting on medications to lower cholesterol, or to assist with bone density may help prevent issues in the future. Likewise, many experts (self included) would recommend taking low dose aspirin to decrease risk of cardiovascular disease.

Looking at the bigger picture, taking steps to critically look at your quality of life, diet, getting regular exercise and avoidance of tobacco should be done to improve both your quality of life, not just the quantity of life.

I hope that helps and look forward to answering your questions for another decade. BY

Starting Antiretroviral Treatment
Worried Child

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