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I want to take ART once a year

Aug 20, 2017

Hi doctor. My CD4 count is 784,viral load is 1286 and I don't want to take ARVs I only want that one we take yearly as am afraid I will forget to take them sometimes as am always busy at work

Response from Dr. Young

Hi and thanks for posting.

You should know that international and many national (including the US) treatment guidelines strongly recommend starting HIV treatment for nearly all people living with HIV, irregardless of CD4 count or clinical symptoms. This is because there is very clear cut science that treatment (even in people with normal CD4s) reduces the risk of death, AIDS, cancer and serious infections (like tuberculosis). Moreover, being on treatment with an undetectable viral load eliminates the risk of transmitting the virus to others. Today's HIV treatments are remarkably effective and rarely cause serious side effects. Most people experience few, if any, side effects. I strongly agree with the guidelines and all of my patients who are willing to be on medications, are on medications.

You allude to your concern about being too busy at work to take medications on a regular basis- yet today's medications can be taken once a day, many without regard to food. And while treatment adherence is important, perfect adherence is not essential to the medications working optimally. Most experts think that getting 90% of the medications is adequate. Mere humans, actually about 18 million people around the world are taking meds and despite all the irregularities of their collective lives, the vast majority are succeeding in achieving viral suppression (and thus, must be capable of adequate adherence). Indeed, today's HIV medications are among as good as we have for all medical therapies, and only a handful of diseases offer treatments that are less frequent than once daily.

Currently there are no HIV medications that can be dosed less frequently than daily. There are active investigations for treatment regimens that could be administered once a month, or every other month, but we will need additional time (probably in the neighborhood of 1-2 years) in order to know if they are effective and safe.

As a matter of human and individual rights, no one should force you to receive any medical intervention you don't want or don't consent to. Yet, you should make the decision to start HIV medications fully informed of the scientific evidence and of the potential benefits and risks to you.

I'd encourage you to explore how others are doing with their medications and adherence- either by surfing the pages and blogs of TheBody.com or by asking friends, your community or medical providers.

I hope this is helpful, BY



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