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What is my long-term prognosis?
Oct 12, 2004

Hello Doctor:

I was diagnosed with HIV in February 2003, and began taking Combivir and Viramune in April 2003. At this time, my viral load is undetectable and my CD4 count is 846. Since begin diagonosed I joined a gym and weight train 4 to 5 times a week. I also eat right, don't drink, and don't smoke. At the age of 41, with these factors - along with no drug resistance based on a genotype test- what is my long-term prognosis? How long could it be before I develop AIDS? What kind of lifespan am I looking at? Anxiously waiting for your answer!!!

Response from Dr. Sherer

It's not possible to give you a single answer to your question, but there are reasons for optimism, and reasons for concern, in the facts that we do know about HIV treatment.

We are only 8-9 years into our experience with "HAART", i.e. three drug combinations. We can say that many individuals - as high as one third to one half in some studies - have done as well as you have for a period of 5 or more years. You are more likely to have a course like these individuals becuase you have gotten through the critical first 6-12 months of treatment on your first regimen without difficulty. One epidemiologist went as far as to predict that such individuals - eg age 40, doing well on ART, otherwise healthy - could have a normal life expectancy, i.e. another 30+ years.

I personally believe that assessment, knowing many individuals who have done very well for a long time, as you have.

On the other hand, there are still reasons for concerns. Excellent adherence to meds, as you must have achieved, can wane over time as people experience 'pill fatigue'. Resistance can occur even when no reason for its emergence can be identified. While most drug toxicity is short term, others can occur after years of therapy. So the answer is good news and bad news; both messages are important.

So I won't encourage you to give up the hope of a quite normal life expectancy and quality, because you have every reason to hold those hopes close. Nor will I encourage you to overlook the realities of living with HIV in 2004, which - even in someone like you who is doing so well - require that you continue to respect the virus and do your best to keep it in check with the best adherence possible.

And, of course, I urge you to continue to share these questions with your doctor.


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