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20 years with HIV, Without treatment

Nov 17, 2005

I am turning 50 in a few days. I was diagnosed HIV+ early in 1986 in Zambia, Southern Africa where I still live. I have had no major problems. I have gone through TB treatment and have troublesome piles. I try to consistently supplement my diet with so-called immune boosters, vitamins and am on Bactrim (480gm x 2 daily)although I miss this a lot because of my kind of job. I have not started medication although my employer would meet the cost. I have a great fear that whatever it is in mys system that has kept me in this shape despite the long time infection might just break under the influence of unnatural chemicals in the drugs. My CD4 count has been around 400 for about four years but recently it went down to 240. I would like to strat medication but am failing to make that decision because I fear to unstabilize that which has been holding my health together. What do you think?

Response from Dr. Frascino


Deciding to begin antiretroviral treatment is indeed a major decision. However, if your major fear is that HAART (highly active antiretroviral therapy) might change whatever has been keeping you so healthy, you need to take another look at your CD4 counts. They had been "around 400 for about four years," but recently declined to 240. I would suggest you repeat that CD4 count and get an HIV viral load test, if possible. If indeed the stable CD4 counts you've had over the past four years have now dropped into the mid-200 range. That is a significant and worrisome change in and of itself.

Your fears that HAART might change something need to be balanced against the reality that something has already changed your stable CD4 count. When your CD4 count drops below 200, you become more susceptible to opportunistic infections. Guidelines from many organizations suggest you should being HAART therapy when your CD4 count drops consistently into the 250-350 range. AIDS medications may be "unnatural chemicals," but nothing is more unnatural than a virus that gradually destroys your immune system. The benefits of HAART, when taken appropriately, far outweigh the risks. Read through the information on this site related to HIV medications. In particular, I recommend "HIV Medications: When to Start and What to Take." Once you know and understand the facts, the risks and the potential benefits, you will, I'm quite confident, make the right decision.

Good luck and Happy Birthday!

Dr. Bob


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