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HIV+ results. Start meds now or later?
May 20, 2008

Dear Dr Rob,

I have posted before about the worry of being diagnosed as HIV+. I have just got my results back, three weeks post-exposure and as I expected I tested positive. The tell in the end was a viral rash, but for the last three weeks I have had very disturbed sleep patterns. Waking 2 hours after going to sleep and not able to get back to sleep. I am worried that this will continue for the rest of my life and it is something that I know will drive me insane.

Questions: Do you think this will pass and I might get back to my normal sleeping patterns? Do you think that I should be going on medication now to hit the virus hard and fast and would this bring my sleeping patterns back to normal? I have an appointment with the clinic, in London, to discuss these questions in two days time, but your comments would be appreciated.

I clearly want to live as NORMAL a life as possible as an HIV+ man.

Regards, Paul

Response from Dr. Frascino

Hello Paul,

Sorry to hear about your recent positive test. I'm glad you have an appointment for additional evaluation in two days' time. Hopefully this appointment is with an HIV specialist. If not, you should establish care with an HIV specialist as soon as possible. The first thing that should be done is to confirm your initial positive result with a repeat test (ELISA plus Western Blot if positive) and obtain an HIV plasma viral load plus an absolute CD4 count and CD4%. We would also recommend a resistance test to ascertain if the viral strain you contracted is resistant to any antiretroviral medications.

To specifically address your questions:

a. Yes, your sleeping pattern will return to normal. Your disturbed sleep was most likely due to stress, anxiety and worry about possibly being HIV positive. Once you have adjusted to this new reality and taken control of the situation, your sleep should improve significantly. HIV infection in and of itself does not affect sleep!

b. Should you begin antiretrovirals now to hit the virus hard and fast? The answer is we really don't know! Certainly if we had safe, non-toxic, well-tolerated, effective and potent antiretrovirals, the answer would be an easy "yes"! Unfortunately our available antiretroviral drugs have significant potential side effects/toxicities, both short- and long-term. Hence we need to weigh the potential risk of therapy against the potential benefit of early intervention. Recent information on how rapidly HIV invades the gut and causes problems with gut immunity has led many of us (particularly immunologists) to recommend treatment sooner rather than later to protect gut immunity, preserve immune function and decrease immune activation! My personal opinion would be to start therapy, but we don't have enough scientific data collected yet for me to back up that opinion with hard data. I suggest you talk to your HIV specialist and get his opinion as well.

Paul, you should also begin to learn more about HIV in general, including HIV's monitoring tests and treatment options. A good way to start the learning process is by accessing the information on The Body's homepage under "Quick Links." There you will find whole chapters titled "Just Diagnosed" and "HIV Medications" among others.

Paul, I've been HIV positive since January 1991. I want to assure you there can indeed be quality life after an HIV diagnosis. I'm here if you need me, OK?

Good luck.

Dr. Bob



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