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Starting Treatment for Non-
Oct 20, 2000

I was diagnosed HIV+ in 1990. My CD4 counts went down slowly for the first few years, but have stabilized in the 500 to 600 range, with a viral load consistently around 1000. I generally take care of myself in terms of exercise, nutrition, sleep, stress reduction, etc. Because things are going quite well, I'm extremely reluctant to start on HIV treatment drugs. My problem is this. For the past year I have had an eye problem (I think the eye specialist calls it 'vitreitis') which causes vision in my right eye to be impaired by a 'fog'. We've been using a medication called Inflamase without much success. My HIV specialist has suggested that I should consider starting HIV treatment for a few months, and then stopping until it's needed again. She states that the newer drugs are so effective that they can suppress HIV and then be stopped without developing any resistance. I can find nothing to support this approach. Is it plausible? Is there documented evidence that this would work? What should I do? I am afraid that starting treatment could throw off the balance I have right now.

Response from Dr. Stryker

Based on the information you have provided, I agree with you. Your CD4+ is still high, and more importantly, your viral load is low -- very low. You are a "slow progressor", and although it is likely that antivirals are in your future, it need not be now. There is no evidence that treating chronic infection with short bursts of therapy, then stopping, provides any meaningful benefit. Although the risk of resistance is indeed small with such a strategy, if well-planned, it is still present. More importantly, what is to be gained? Unless your doctor strongly feels that your condition is secondary to impaired mucosal or ocular immunity, I'm doubtful you would have a durable improvement.

That said, if there are multiple other nagging "non-HIV" related problems, including fatigue, than perhaps you should consider starting antiretroviral therapy at this time. But do it for the right reasons. At this time, I think it sensible to view antiretroviral therapy as lifelong, in general, especially in cases like yours where infection has been present for a decade or more. Good Luck to you! RAS

Rick Stryker, M.D., M.P.H.



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