Odds of Severe Side Effects vs. Odds of Developing OIs
Oct 10, 2003
Dear Doctor: With some horror, I have read on this website some of the possible side effects of anti-HIV meds. Particularly troubling is the occurrence of heart attacks and liver complications. I wonder, how does one balance the odds of developing a severe negative reaction to the meds. vs. the likelihood of developing OIs without the meds. I mean, I obviously want to avoid developing any OIs, but if it means I may drop dead of a heart attack or liver failure , or have to take a seeminly endless number of medications (e.g., to reduce cholesterol, lipid levels, etc.), then I don't know if it's worth it. I'm relatively sure I know what your response will be, but I just wanted to bring this issue out for discussion. Thanks!
Response from Dr. Conway
This is the key question: given that, in most cases, the treatment for HIV infection will be a life-long affair once it is started...WHEN TO START???
Well...this would be when the benefits of treatment (avoiding disease progression or death) outweigh the short and long-term toxicity of the drugs themselves.
When the CD4 count is above 350, the risk of disease progression is so low that it is best to wait (given the drugs available to us today). If it is below 200, the risk of the disease progressing is so high that treatment is mandated. With a cont between 200-350, the decision must be individualized based on the individual's commitment to treatment, the comfort level the person has with various side effects, the rate of decrease of CD4 count, and other factors.
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