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l think hiv meds are worse that hiv

Jan 16, 2009

Hi Dr Bob,

l have been hiv positive for 5 years and going to doctors appointments every 4 months to do blood work, my cd4 count is now 167 and virol load 600,000 on my last test, but feel ok,

my doctor wants me to go on meds, but l don't want to and think l dont need meds,

hell look at the side effects of meds, and the effects it has on the heart and liver and kidneys,

l told my doctor l want to wait to better meds come out with less side effects and toxicity,

Dr Bob how long before a new breed of meds comes along with less toxicity and side effects ???

l know l am being stupid but this is how l feel, my mum and dad said if l get under 100 cd4, they will make me take meds... l am 25 years old.... and have spoken to people on meds, and all they do is go to the toilet all day and have no energy,and have funny face shape ...

thank you for your time

Response from Dr. Frascino


Nearly all HIV-positive people will need treatment with antiretroviral medications at some point. It's not uncommon for HIVers to worry about side effects and toxicities related to these potent, but highly effective medications. Sometimes these fears even delay the recommended start of treatment. HIVers who have these fears are often too young (like you!) to remember the devastation that AIDS caused during the pre-HAART (highly active antiretroviral therapy) era and are unaware of the catastrophic effects untreated HIV/AIDS is still causing in parts of the world that don't have access to these therapies.

When HAART first became available in mid-1996, an aggressive approach to treatment was recommended ("hit early, hit hard") primarily because we realized the life-saving potential of these new therapies and the possibility that such treatment might actually cure HIV! But cure turned out to be a mirage. And we found that these drugs could be toxic and that without near-perfect adherence to drug dosing that resistance to the medications would emerge. Guidelines were developed and since have been modified several times to reflect these realities, but also to take into account the newer, more convenient, less toxic agents that have more recently been approved. In fact the pendulum is now swinging back toward starting treatment earlier again exactly because therapy is now easier to take, better tolerated and much less toxic!

I'm sure your HIV specialist has advised you that current guidelines strongly recommend HIVers begin treatment when their CD4 count falls to 350. Yours has fallen to the dangerously low level of 167 and your HIV plasma viral load is sky high at 600,000. There is absolutely no controversy about whether or not HAART should be started with numbers like yours. You absolutely need treatment now. It's important to note that the AIDS epidemic is now more than a quarter century old (older than you!) and we know an incredible amount about how untreated HIV leads to a slow, miserable, undignified death. Why are you going back to the 80s when you live in the 21st century? I urge you in the strongest terms possible to take advantage of what medical science has to offer and save your life! Had I not begun HAART years ago I would not be here to respond to your concerns. The choice is yours, but your current decision to postpone treatment is already having devastating consequences for your chances of long-term healthy survival. I urge you to wise up and soon!

Dr. Bob

Confused and Frustrated

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