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Depressed and Need Some Reassurance? Anxiety is really killing me!!!!!!!!
Aug 19, 2001

Dear Dr Cal Cohen,

Thank you for all the support that you and your colleagues provide on this highly educational web site for those affected by HIV/AIDS.

I was infected about three years ago and I am not on any medications at the moment!!! My doctor has said that I can still wait further to get treated!! My viral load is 2500 and CD4 is 450!!

I am only 25 and I have had an excellent education!!! I have an MBA!! I come from a very affluent background!! I have been spoiled rotten by my parents all my life!! I never thought I can be infected with HIV because I was so careful with sex except with one person, this person I trusted most at one stage of my life ( My ex girlfriend while at University) passed the virus on to me without knowing!! When I found out I was absolutely shocked and gutted !! I was so so depressed!! I had my whole life ahead of me!! There has been times I wanted to end my life!!! I have always practised safe sex, I have never taken any drugs, I don't smoke and I enjoy sports such as golf, tennis and rugby! I come from a rich family and to some extent they found it hard to believe and accept at first!! but they eventually did!! I guess I am luckier than some others who don't have access to good medical care as I do!! But what really depresses me most is when I read around the internet about how the pharmaceutical is going cold towards developing more potent drugs in combating HIV and how they are going cold on trying to find a cure for HIV!! In one report I read scientists believe that HIV is a virus which lies dormant within the human cells !! and it might take 73 years to eradicate HIV from those who are infected!! All this makes me depressed sometimes as the chances of finding a cure in my lifetime is slim!!! What do you think!! Given that Protease were only developed five years ago?? do you think there will be more progress in the future!! Do you believe given the outlook of current research a cure can be developed within the next ten years!! (Are there any concrete and positive evidence which may give us positive hope??) If yes, can Medications buy me the time and a good quality of life till then!!If I start medication soon and I adhere strictly to taking them them !! Can I possibly go on a combination therapy ((There are lots out there and I don't know which ones to take in terms of being the most potent, most tolerable and not highly sensitive to resistance if you are slighly late in taking the dosages)) which will enable me to have a normal life except the inconvenience of taking so many pills a day and short term side effects!! What do you think !! Do you think I can live a long life or shall I just give up!! This anxiety has taken over my life!! I know it's really stupid for a higly educated person like myself but every human needs reassuring and I really have a lot of faith in you since I have followed this web site very closely in the last three years.

Please respond!!! God Bless you Doc!!! You truely are a wonderful person for giving us so much of your time!!!!



Response from Dr. Cohen

Chris - thanks for your comments and appreciation. It is what keeps this site going.

As for your situation - you describe many issues so let me address as many as I can.

First - your own numbers suggest you are among the few and fortunate ones (in a few ways as you note). That your viral load off medication is only 2500 puts you in a category of only a few percent of those who are positive -whose own immune system is able to control HIV to this degree. And these number suggests that your body would be able to cope with this much HIV over time - meaning that the amount of T4 cells that are destroyed by HIV are low - and your immune system will be able to keep up production to meet this need. The other thing noted is your age - since your thymus gland - in the center of the chest under the breastbone - is still functioning well when we are less than about 40 years old or so - and the thymus is responsible for the maturation of T cells (hence the name), including T4 cells. And so yes, you can wait further to start treatment if you wish to do so. And this certainly means you have an excellent chance of a long and healthy life, since if there ever comes a day that your numbers should change and you do need to start treatment, there will be not only the meds we have now, but others as well. And ongoing knowledge to help guide what we should do at that time to do our best with the tools we have.

And sounds like you are staying well in the other ways that matter - like exercise, avoiding cigarettes and other toxins. And that should only help.

As for the cure, it is hard to know if we'll ever have that day arrive, based on the issue you mentioned = HIV itself hides inside cells that live as long as we do - which means that a cure would have to eliminate all of those cells. And we just don't know how to do that yet. So we are closing in on the next best thing - which is to define approaches that may help the immune system do what yours is already doing - to contain HIV from doing us harm. Since those with counts such as yours stay well despite low level HIV infection. And it may be that in time we'll learn how to augment the ability of your immune system to do even better at controlling HIV - to further reduce any harm that comes as a result of the growth of this virus.

As for these meds we have - yes we have lots. And yes we need more. And we do fear that in time some of the pharmaceutical companies will no longer invest in this field - since there are many pressures on companies to do research in competing fields of medicine. And while HIV is important and has been a line of profound success, there are some companies that may, for a complex listing of reasons, put their time, energy, and money, into other illnesses. But some continue to do so, and the tools we have now should increase still, albeit at a slower pace than the need may be.

But if the day arrives for you to start treatment - there are options. There is flexibility and increased ease of dosing. There are combinations that are just one or a few pills once or twice daily. Those starting have more options and more success than others - and so if that day arrives, you should have little trouble. But for now the task is to find a clinical team you want to work with - since that is one essential key to ensuring that whatever is done is done with all of the benefits we have available to us.

Finally, with the financial resources you are fortunate to have - you may wish to consider supporting some aspect of this field. There are many many organization in the US, and around the world, all of which are focussed on improving the lives of those with HIV. There are direct service groups, and there are treatment researchers - all of which rely on donations to do what they do. And so you may find it fulfilling to support those who do work you find important - to add to the sense that you are doing all you can do.

Finally one last point. Your keyboard seems to substitute a double - or more - exclamation point for a period!! Maybe an expert can help figure it out!!! Or maybe you are just an emphatic kind of guy!!!!


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