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HIV Drug ResistanceHIV Drug Resistance
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Apr 5, 2008

hi Dr.Sherer,

how long does the average person live who is living with HIV if he /she was diagnosed early enough , take meds as prescribed, exercises, and easts health in these days of the disease? I am 22 and was diagnosed a few month , it is believes of contracting the virus, I have been call a good patient by my doctor because I am very proactive and takes meds as prescribed.I have been on combavir and Sustiva for at least two weeks now and fealing like my old self. When diagnosed my CD4 was 212 just borderline and viral at 14,000. Now I am at 700 viral and CD4= 362, i am pleased. My mother knows that that I have it , do you think that it is important that my other relatives know to, some of them are I must say have a very old understanding of the illness, " death sentence" if you will. My Doctor comforted my mother and she tells me that I must live life as I would if I did not have the disease but must get very serious about who I partner with and make sure that they are supportive before intimacy etc.What is your take on this all?

Response from Dr. Sherer

In the current era of HIV treatment, 80-85% of people have a response to ART like yours, with full viral suppression and rising CD4 cells. The estimates for long term survival are highest for someone who 'gets it right' with the very first ART regimen, i.e. who maintains good adherence from the start and achieves a positive initial response. There are clinical trials of ART in which the majority of people on ART have done well for seven years, and cohort studies in which patients are well controlled for 10-15 years. It is certainly possible that you could have a normal life expectancy, but we have not had enough cumulative experience to be able to give a credible estimate of the likelihood that that will happen.

In the meantime, you can increase your chances to the greatest extent by continuing your fine record of adherence and keeping all of your doctor's appointments.

The issue of disclosure is an important one to talk to your doctor about. Whether or not it would be a good idea to let other family members know of your status depends on many factors. At a minimum, I would take your time with this decision, since you can't go back once you do share this information. Families are tricky, and you will have to make this decision for yourself, with your doctor's counsel. You might also ask your mother's opinion.

I agree with your mother that you need to live your life as if you didn't have HIV, in so far as that allows you to realize that HIV does not define who you are, nor should it dominate all of your life. On the other hand, you do have HIV, and you do have to show an adequate amount of respect to the virus in order to take care of yourself and treat others respectfully.

You may not have to be serious about each and every friend that you make, but you certainly should be truthful with any potential sexual partner and disclose your status to that person before you have sex. This is both to prevent your spreading the virus to another person AND to prevent you from acquiring a second strain of HIV or another sexually transmitted disease. That does create a major additional obstacle to intimacy...but its not an insurmountable obstacle. Most people living with HIV in my experience find a way to be intimate with another person, even if that process takes several months or more. I would advise disclosure early in a relationship, if you feel that you might want the relationship to develop further and include sexual relations, to be sure that you are not perceived as misleading someone that you care for. If that person is unable to handle being with someone who has HIV, which is one possibility, then you are both better off knowing this early.

I suggest that you talk to your doctor about all of these important issues.

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