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Suddenly SUPER depressed with HIV
Jan 5, 2006

Hi doctor: I have been HIV+ for 6 years. I have been on a few different meds (VIRACEPT+COMBIVIR) that never really worked. Even with viral loads of 5000-16,000 my t cells never budged between 300 and 400. Now I am on Kaletra, Viread and Epzicom and the viral load has been <175 for 9 months with T cells the same 400. Have never been entirely undetectable, although now I have been close for 9 months. I am resistant to NNRTI's which I never took. I have a great body, no lipo, an intense appetite but now I have an amazing amount of despair. I have worked VERY hard mentally in therapy getting to the point where I accept HIV as (manageable but chronic like diabetes). Now I recently have been reading that the meds only "prolong" your life "possible as much as 10+ years if you can achieve viral suppression <50 over an extended period of time". I am very driven in my career and my life and feel like I am just wasting my time now putting away for my retirement and boiling my life for the future. For what? Even in the most ideal situation of viral load total suppression I can expect a decade or more? So, since I have never achieved total suppression, but look great and never had an HIV related illness, can I expect in 10 years to pretty much die an awful death with my family around me saying "I told you so?" I am really disturbed by all of this, considering I have been living under the assumption that my disease is manageable. Now, I am thinking since I have clear resistance in place that maybe 8 years is more like it for me. Should I continue to put away for my retirement? Will I even get to enjoy it or should I just use the money for here and now pleasures? Again, this just really hit me last week when having a conversation where a friend of mine said he spoke to an HIV expert who told him that "people with HIV, even with treatment can't expect to live very long". So, this is where I am now 3 days after Thanksgiving and thinking "what's the point of even going to work and exerting so much energy". Can you help clear this up with some real concise answers? MUCH appreciated

Response from Dr. Horwath

Your treatment response has been quite good, but not perfect. The low viral load and T cells of 400 indicate a very good prognosis for you.

The fact is that nobody knows how long any individual will live, with or without HIV infection. We cannot predict, even with the best science, a person's lifespan. The figure of 10 years comes from the fact that HAART has been in wide clinical use for about 10 years. We can only say with any certainty how HIV infected patients are likely to do over 10 years because we don't have any data over a longer period of treatment with HAART.

You may yet lead a long life, well beyond 10 more years. The "expert " that your friend quoted does not have a window on the future, and clearly has not had the experience of treating people who have had HIV infection for more than 20 years (as I have).

Your best ally in leading a long life is to remain hopeful and positive about your own future, and to avoid people who predict doom and gloom.



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