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HOW LONG WILL I BE HEALTHY???
Mar 24, 2002

HI. I am 29 and recently found out I am positive. My viral load was 440,000 and my CD4 was 380-400. I started a treatment of Viread, Viramune and Epivir. I have been on it two months. My new labs are Viral load 1300 CD4 800....my Doctor said these are amazing. I agree and am very excited about the increase in my CD4. My question how long can all of this last? I know everyone is different. We think i have been positive for only 18 months since I was tested 18 months agoa nd was negative. Do we know any more information about life expectancy ? Or if someone can be HIv and not get AIDS for a long time and what is a long time? 5 years, 10 ??? I am so confused and really freaked out. PLease help

Response from Dr. Cohen

Sure thing. And hold on don't freak - there is good news coming.

The breakthrough in HIV came a few years ago when we learned a key lesson - how to stop the damage by HIV by using meds powerful enough to stop it from growing. That breakthrough taught us that we need to drive the viral load down to very low numbers - like a count <50 copies. When we do this - the combo continues to work for years and years. This is because, at these very low counts, HIV has very little if any chance to create resistance to the meds you are using - so the meds keep working to stop it - and this stalemate can keep going. How long it can work for is in part up to you - as we have learned that these meds can and do work for many for years and years and perhaps indefinitely. However - one key reason they stop working sooner is erratic dosing - the occasionally missed dose. It is sadly normal to miss a dose of meds now and then - people forget, they leave them home, went out somewhere and didn't get home that night and so on... You are on a combo that can be taken all just once a day - and that may make it even easier to ensure long term success. And, especially in these first several months while you drive the viral load down to <50 copies - maintaining the blood level of these meds is key to their success. With this issue handled by you - you are very likely to have success and maintain it.

There are potential reasons why, despite this, a combo may not work forever. One is unexpected drug interactions with things that may lower the blood levels of your antivirals - given the combo you are on, this is unlikely as there aren't many to think about -- just remember to take the Viread with food and your levels should be steady. The other reason for surprises might be reexposure to a new resistant strain - this is far more controversial and rarely documented -- but there is at least some theoretical concern that if you were intimate with someone who had a viral strain that was resistant to, say, Viramune -- that strain could take hold and cause havoc. So stay safe...

With these issues addressed by you - the only thing left to do is ensure your viral load gets to <50 sometime in the first 6 months or so. Given your initial viral load - and response - you are on your way there - and should get there by month 6 - maybe before. Your combo is likely to be potent enough to get there - and so far it seems from your response that your virus is sensitive to these meds - that is why your response is as good as it seems. The CD4 bounce is also good news - and reflects in part your age - the T cell factory is still intact!

So - if all goes well with continued regular pill taking - it is reasonable to be optimistic - the news in HIV treatment is encouraging and combinations like this seem to have few enough toxicities to hope they can last for years and keep you well - while we can't say for sure, it seems reasonable to even anticipate you can have a normal life span - meaning you can think long term. So - no smoking, eat well, avoid the risks of party drugs, exercise, and enjoy.

Hope that clarifies.



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