May 24, 2004
My sister was diagnosed as HIV positive more than 10 years ago. She for more than 5 years been at undetectable load levels. She is frustrated she's taking as many as 18 pill a day, most of which seem to be causing more problems tha providing any solution. I fact on doctor told her that if she was dianosed today that would have prescribed 'NO" medication for her! She is currently so angry she plans to stop taking her medication altogether. I've told to try to sort it out with her doctor, but I'm worried about what she will do. I assume she would be considered a "nonprogressor", are there any new rule of thumb of how to treat them? Are many of then being taken off medication or are having their therapy modified?
Response from Dr. Boyle
Long-term nonprogressors are able to control their virus, without medications, better than those with more rapid progression and these patients are treated just like everyone else, with careful monitoring of CD4+ cell count, viral load and clinical signs or symptoms of HIV disease progression. If your sister has been stable on medications, than she is not a long-term nonprogressor as that term is generally used. Since you don't provide a lot of information it is tough to give you any specific advice; however, if your sister has reached the point where she questions her doctors advice and is going to disregard it, it is time for her to see another doctor, either for a second opinion or to transfer her care. If she started antiretroviral therapy with a relatively high CD4 count, than it may be OK to interrupt therapy with careful monitoring. Certainly, the pill burden should be addressed, since if she does not have a very resistant virus, she should be able to cut down on those signficantly, and perhaps even get on a once-daily regimen.
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