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The Dirty Truth on LIfespan
Nov 10, 2005

Hi doctor: I have been positive for 6 years and have never been undetectable. I have had viral loads of about 135 for 9 months now and before that was on other medicines with viral loads in the 6-15,000 range. My T cells never have changed, whether I had a viral load of 100 like I do now or 15-20,000 like I did 3 years ago. The T cells always are between 295-405. I always hear people who claim to know a lot about HIV saying "O HIV isn't like it used to be, now you can live 20 years". That to me is quite depressing to know that I can expect to live longer but ultimately my demise will be an awful and brutally draining one brought on my the onset of the inevitable. Is that truly the diagnosis of HIV? That people will live longer but eventually die of AIDS? Are people's assumptions correct? Even though I am as healthy as an ox, have a great body, no side effects and a constant 300-400 T cells am I one of those people that should expect to die of AIDS in 10-15 years since meds for me aren't necessarily forever keeping me at the infamous "undetectable"? I am curious on an answer to this and can't seem to get some true expert advice. I appreciate all the work everyone does on this site.

Jason- New York City- 31

Response from Dr. Frascino

Hey Jason,

Believe it or not, when folks say, "Oh HIV isn't like it used to be, now you can live 20 years," they are actually trying to cheer us up, not bring us down. The possibility of living 20 years after you were diagnosed in the early dark days (years) of the epidemic was indeed a concept we only dreamed about. All that changed in the mid-1990s when protease inhibitors (and subsequently other potent anti-HIV medications) were introduced. Morbidity and mortality rates plummeted beyond our wildest expectations. Phrases like "chronic manageable condition" started popping up. Unfortunately, subsequent to that came phrases like "metabolic abnormalities," "lipodystrophy/lipoatrophy" and "drug resistance," which reflected some of the adverse consequences of taking the new miracle medications for long periods of time. So where are we today? Should you expect an "awful and brutally draining demise" in 10 to 15 years? No, I certainly hope not. How long will HAART medications control our HIV infections? No one really knows. As I mentioned above, these meds were first introduced in the mid-nineties and newer, more potent, less toxic meds continue to be developed and released. Where will we be 10-20 years form now? No one has a crystal ball with that kind of accuracy. But with the strides made so far we can hope for continued advances as the years go by. Of course if even a fraction of the 300 billion dollars we wasted in Iraq had been spent on AIDS, we'd probably have a cure today. (Same goes for cancer, diabetes and many other "incurables.") For now, Jason, focus on the positive. You're here and your "healthy as an ox, have a great body, no side effects and a constant 300-400 T-cell" count! I assume you are working closely with an HIV/AIDS specialist. (If not, you should be.) Your viral load of 135 is nearly undetectable. Other regimens or intensifying your current regimen might knock your 135 into the "infamous undetectable" range. However, that change in meds may also cause side effects affecting your "ox" (as in "healthy as an ox") status. There is nothing magical about "undetectable." Sure, it's a target to shoot for, but if your T-cells remain stable and your viral load remains extremely low, that may be good enough for now. Adjustments can (and will) be made as better drugs become available or as your numbers change. So what about the future? Who knows? Gosh, fifteen years ago, who would have guessed dimwit Dubya would be inhabiting the White House, reeking havoc on everything he touches? Then again, I guess we did have Daddy Bush back then and as the saying goes -- the moron doesn't drop too far from the tree. Well, anyway, as far as HIV is concerned, I'm planning on dying of old age, not opportunistic infections. Care to join me?

Stay well, Jason. (That's what it's all about.)

Dr. Bob



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