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Do we need to start HIV medicine, India.

Jun 1, 2007

Dr Frascino,

My brother was infected with HIV in '01. I am currently in the U.S. His Cd count was 272 3 months ago and now its 208 after he was confined in a rehab center with proper food, care and medical treatment. As of now we do not know his Viral load and doctors in India apparently didn't do the viral load last time or now. They insist its time to start HIV medicine and there is no going back ? I know this is very little information, but if you could please tell me what all you need, i could provide you for your guidance. Being from a poor country with controversies and social stigma, its getting difficult to go to a doctor who doesn't staunch or start acting differently while treating my brother and/or millions of Indian patients. Please help. Thank you. P.S. Does starting HIV medicine means its getting worst and or serious than it was......(i know the answer to it, but don't have the guts to admit it. He's my little brother). Also the medicines are expensive and not updated in India so I am worried about side affects.

Response from Dr. Frascino


If your brother's CD4 count is consistently in the 200-300 range, published guidelines worldwide would suggest he begin HAART (highly active antiretroviral therapy). Should his counts fall below 200, he would be at increased risk for opportunistic infections, such as PCP (pneumocystis carinii pneumonia).

India has been a leader in producing generic versions of HIV medications to significantly reduce cost. Side effects with any medication are always a possibility; however, when the CD4 count approaches 200 the risk of drug side effects and toxicities is far less than the risk of uncontrolled progressive HIV disease. Starting medications does not mean he's getting worse! In fact by starting medications he may very well get significantly better. I certainly did when I started them over a decade ago! I'll reprint some information below about starting therapy. You can find much more by reviewing the wealth of information on this site and its related links.

Good luck to both you and your little brother!

Dr. Bob

When to Start Treatment? Part of HIV Medications: When to Start and What to Take

November 2006

Doctors still disagree about when is the best time to begin HIV treatment, also called antiretroviral therapy. You and your doctor will need to determine this together, but there are some respected guidelines. Be aware that these guidelines are regularly updated and are not hard-and-fast rules. They are just suggestions based on the most recent research. For example, the U.S. government's Department of Health and Human Services HIV Treatment Guidelines (view PDF of guidelines) recommends that you begin HIV treatment if you have any serious symptoms, or before your T-cell count falls below 200. Some doctors prefer starting treatment if your T-cell count is above 200 but below 350, in hopes that starting treatment a little earlier will help your immune system stay healthier.

Once you start taking HIV medications, you'll probably have to take them for a very long time, so you and your doctor will want to make sure you are absolutely ready before you begin treatment. This way you can postpone possible medication side effects (which we talk about later in this booklet) and make the most of the powerful initial effect medications can have on the HIV in your body.

Current Guidelines Recommend

If your T-cell count is 350 or above, treatment is not recommended unless your viral load is 100,000 or higher, or you have serious symptoms.

If your T-cell count is between 200-349, treatment should be seriously considered.

If your T-cell count is below 200, to avoid dangerous illnesses, start treatment.

All studies indicate that it is best to start HIV medications before your T-cell count drops below 200 in order to avoid dangerous HIV-related infections and illnesses. Your T-cell count, however, will vary from test to test. Often, your doctor will wait for you to have two consecutive T-cell tests that are low before recommending that you start HIV treatment.

What Is a T-Cell or CD4 Count?

Your T-cell count, also known as a CD4 count, reveals the number of T cells in your body. A T cell is a special kind of white blood cell, and the more you have, the stronger your immune system is. When you were infected with HIV, the virus entered into some of your T cells. When these HIV-infected T cells make more copies of themselves, they end up making more copies of HIV as well. HIV can also destroy T cells, as well as other surrounding cells. After living with HIV for a while (if you don't take medications) the number of T cells you have will usually go down. This is a sign that your immune system is being weakened. The lower your T-cell count, the more you risk getting sick. A normal T-cell count for someone without HIV is usually between 500 and 1,600.

What Is Viral Load?

Viral load levels tell you and your doctor how much HIV is circulating in your blood. The more HIV in your system, the quicker your T-cell count tends to drop. This makes viral load a helpful predictor of the health problems you may develop if you do not take medication. It is also a good measure of how well HIV medications are working once you begin treatment. Your viral load count measures the amount of HIV per milliliter (mL) of your blood. Current viral load tests can detect as few as 50 copies of HIV per milliliter of blood. When you have fewer than 50 copies/mL of HIV, your doctor will tell you that your viral load is "below the limit of detection," or "undetectable." This does not mean that there is no more HIV in your body. So even if you are "undetectable," you can still transmit HIV to someone.

Getting Into Good Habits Before You Start Treatment

Even before you begin treatment, you may want to change your life. Now is the time to eat well, exercise, and if you smoke, drink or use recreational drugs, stop these unhealthy habits. Recent studies have shown that smoking may be particularly risky for people with HIV. Before you put anything into your body, consider if it is good or bad in your fight against HIV. If it doesn't pass the test, avoid it. You need to maintain and strengthen your immune system. If you are taking any drugs, vitamins or supplements at all -- prescription, over-the-counter or recreational -- make sure you tell your doctor so that you can avoid dangerous interactions with HIV medications. For example, antihistamines, birth-control pills and recreational drugs all have been shown to have serious interactions with HIV medications. Even the herb St. John's wort can reduce the strength of some HIV meds by half.

Can You Really Talk to Your Doctor?

Does he or she listen to you? Choosing a doctor you can talk to is crucial. You'll probably have many questions; make sure your doctor is available and able to answer them before you make any decision about starting HIV treatment.

horrified female.
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