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Do I need to be near medical care for first 7-9 months?
Jan 19, 2010

I just got confirmation of having been infected with HIV during the past 90 days. I am a very healthy U.S. Marine scheduled out for a 7-month deployment to a non-combat position in Afghanistan in early March (March thru Sept). I have spent years training for this deployment and I very much still want to go.

I understand that standard HIV treatment often waits for many years before HAART is begun. If this is the case, it seems like I can still go to Afghanistan for this deployment without any need for U.S. medical care and without jeopardizing my health.

But Ive also heard a more recent strategy that suggests long-term benefits for patients who begin HAART very shortly after diagnosis. In that case, I would need to give up my dream of deployment in order to stay in the U.S. for HAART therapy.

If the marine corps finds out I am HIV+, I will not be allowed to go on deployment. Or if they find out while I am there, they will send me back to America. However, all of my pre-deployment blood testing by the marines was completed a few months ago when I was still negative. As a result, I am currently cleared for deployment.

But as much as I want to do the deployment, I realize I must make a decision based on what is best for my long term health. Can you please tell me

If there is any legitimate, scientific, health-based medical reason a newly diagnosed HIV case should NOT go on a 7-month deployment to Afghanistan?

Since I contracted this within the past 90 days, is it likely I would develop anything in the next 7 or 8 months that would require care - or require a doctor to know Im carrying HIV?

After my initial Viral Load baseline results come back, is there any other recommended follow-up testing that needs to be done in the next 7 or 8 months that would suggest I should stay in the states near medical facilities?

At first, I thought establishing a baseline just meant getting viral load results of one blood test. But is it accurate in the early stages of infection that it may readings from multiple blood tests several months apart in order to get a valid baseline? Would that alone be a valid reason for me to give up deployment and remain stateside?

Is this new strategy of very early HAART therapy really an important consideration for my well-being in the future or would it be just as beneficial if I wait until I come back from deployment in September?

Finally, are there any other medical angles to this that would suggest I should stay near medical care in the U.S. during these next months from March to September (instead of going to Afghanistan where I would not be able to let any medical person know I am HIV+ ?

Many, many thanks for taking a look at this. Your guidance will be much appreciated.

Response from Dr. Frascino

Hello Marine,

1. Is there any legitimate, scientific, health-based medical reason a newly diagnosed HIV case should NOT go on a seven-month deployment to Afghanistan? Yes, there are several. First and foremost, I encourage you to be honest about your HIV status. By doing so, as you note, the Marines will not allow you to deploy. Second, because the Marines do not know about your HIV-positive status, they may treat you inappropriately by, for instance, giving you a live vaccine (yellow fever, for example) prior to deployment. (Live vaccines are not recommended for those infected with HIV.) Third, it is possible, although not yet definitively proven, that very early intervention with combination antiretroviral therapy may preserve immune function and decrease immune activation. Finally, all HIVers, whether on treatment or not, should have regular follow up (every three to four months),including lab work (CD4 cell count, HIV plasma viral load, etc.).

2. Are you likely to develop anything in the next seven to eight months? Most likely not. However, HIV disease is unpredictable and clinical courses vary considerably from person to person. That is why routine monitoring is recommended.

3. Recommended follow-up testing. As indicated above, it is recommended you have routine monitoring and lab work every three to four months.

4. Valid baseline. Yes, it is better to look for trends and the establishment of a viral set point (equilibrium of sorts between your immune system and the virus). This usually takes a number of months. You can read more about viral set points in the archives of this forum.

5. Very early HAART. No one knows the answer to your question. There is theoretical evidence suggesting it may be beneficial, but the clinical studies to confirm this are still underway.

6. Other medical angles. Depending on where you are stationed and what you will be doing, you could be exposed to a number of illnesses not common in the states. Concurrent illnesses can exacerbate HIV infection.

Whatever you decide, good luck. I'm here if you need me, OK?

Dr. Bob



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