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Managing Side Effects of HIV TreatmentManaging Side Effects of HIV Treatment
           
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drug cocktails
Oct 10, 2001

dear dr. boyle. i hear people saying that hiv is now a chronic disease.it has been stated by my dr that this is true.he says i can live a full and normal life. well i have been hearing that the drug cocktails only work for about 15 to 10 years. im 46 years old. does this mean that i will be dead when im 56 or 61 years old? im going to start med this week . the med is viracept and combivar. im scared to death on the side effects. my viral load was 26,000 in july of 2001 , and my t-cells were 435 in july as well in 2001. he told me the right way was to wait or to start. how many t-cells does the virus kills per year? does the t-cells come back up after the meds kick in? will i be dead in 15 years even if i take the meds religiously? what are the most common side effects from people on combivar and viracept? im worried about fatigue or nausea. dr i work for american airlines as a baggage handler is this good to keep my exsersise in compliance. i also work out at home every day.

Response from Dr. Boyle

I understand your concerns, however, the data that currently exists indicates that the current regimens, if they suppress the virus to <50 copies/mL and are taken religiously, may last for 10 to 15 years or longer. During that time, new drugs and treatments will be developed. These will undoubtedly lead to further progress in the fight against HIV and extension of life. So, I think you should remain optimistic and keep yourself as healthy as you can, including using antiretrovirals when appropriate, as I believe the best is yet to come and you want to make sure you're in good shape when we get there. Your current CD4 and viral load do not indicate any urgency with starting therapy and are both better than the DHHS guideline recommendations for starting therapy; however, if you feel you are ready, you want to start therapy and you are prepared to commit to taking virtually every dose, than I think it is reasonable to start. To answer your other questions: (1) CD4 cells generally fall about 50-100 per year (but that is highly variable and can be much more rapid in some patients at certain times), (2) CD4 cells generally rise on antiretroviral therapy but in some patients (for example, older patients) this may not be as impressive as in others, (3) The main side effects of combivir (AZT + 3TC) are fatigue, nausea, vomiting and anemia and the main side effect of Viracept (nelfinavir) is diarrhea. Since you are working and are concerned regarding problems with side effects, you should know that there are simpler, more potent regimens, with fewer side effects, and I'd suggest that you review this site and discuss this with your doctor.



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