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Late presenter - prognosis?
Aug 15, 2010

Hey Dr Keith,

Thanks for answering my previous question re rash & fever from sustiva + Septrin. The rash has now cleared up, and it was really great to have that reassurance. Will be back at the HIV centre next friday. In the meantime I have something really weighing on my mind..

A late presenter - I am heterosexual and never once had unprotected sex outside of a relationship, so (I thought) never had a reason to test. I have had numerous symptoms of late stage HIV, including rash, terrible fatigue, diarrhoea, fuzzy tongue, etc etc

I started medication 3 weeks ago, immediately after receiving results of my first blood tests - cd4 of 170 and vl of 170,000. Sustiva & Truvada. I was previously healthy, 30 years old male, no drug habits.

Everywhere I read about a reduced life expectancy, difficulties regaining "normal" cd4 counts and studies showing that bouncing back from CD4 ranges of 100-200 is noticably harder than if you start taking meds at >350.

This is scaring me, and certainly adding to my stress (and therefore not helping my CD4 in any way!)!

Some studies suggest that if cd4 levels do not rise over 500 I may have less than a decade to live. Other websites and articles suggest a life expetancy around the high 40's early 50s, and others say normal life expectancy.. I don't know who to believe.

Should I still be planning kids with my partner? Keep saving for a pension? Will the symptoms (particularly fatigue and the "death-shits" or diarrhoea) ever go away again or is this something i just need to learn to deal with?

I really hope you can help ease my mind - I can;t concentrate on work or pretty much anything as my head is just reeling with the news.

Thanks in advance,

D

Response from Dr. Henry

For most patients with HIV and access to good treatment the life expectancy is measured in many decades (true even for many late presenters). Achieving full viral suppression (< level of detection) and a decent CD4 recovery (> 350--maybe over time to > 500) increases the chances for very long life expectancy. Working on your global health (cancer, heart disease, diabetes risks) is also important. A high % of late presenters in our clinic achieve full viral suppression and an adequate to good CD4 recovery and move on to planning for other important life events (marriage, children, careers). KH



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