One Doctors' Approach for Preventing Opportunistic Infections
I am sending this to update you on the latest changes in my treatment approaches to HIV/AIDS.
In my practice aggressive opportunistic infection prophylaxis makes a dramatic difference in the rate of serious illnesses and in the survival rate in people with CD4s below 200 and/or 14%. I have been prophylaxing with the following drugs in patients with CD4s below the indicated levels (see chart at end of article).
The Public Health Service recently issued multiple OI prophylaxis guidelines in which prophylaxis for only PCP was recommended. I believe that the level of caution and conservatism reflected in these guidelines, while appropriate in the general practice of medicine, is very inappropriate with a life threatening disease such as HIV/AIDS. There are more than 250 patients with CD4's below 200 in my practice, yet there are few deaths, 7 or 8 per year.
I have attempted in my practice to combine the most useful of conventional therapies with the most useful alternative therapies. I use practical observed results rather than any particular philosophy as the basis for clinical judgments. I have found that traditional Chinese medicine (with acupuncture and herbs) is often very useful, particularly in controlling some parasites, treating some symptoms, managing stress and maintaining good health. I view it as an adjunct to treatment with western drugs as I do the role of good nutrition, antioxidant therapies and aerobic exercise. The traditional herbal systems used in India, Tibet, Africa, the Caribbean, and Central and South American countries are likely to contain therapies of value for people with HIV/AIDS.
My goal is to keep my patients stable and symptom free. The long term goal is to keep them alive and well until a "slow cure" is available. To this end I prescribe low dose naltrexone to patients at all CD4 levels. I generally recommend acyclovir, 800mg 4X/day to control the activity of the 8 herpes viruses as cofactors. I treat hepatitis B and C, with St. Johns Wort to control these two viruses as cofactors. I use aggressive multiple OI prophylaxis as described. I treat minor infections aggressively as they can increase HIV replication. I avoid all vaccinations for the same reason. I use 3Tc & AZT in some of my more fragile patients despite my generally negative view regarding the widespread use of nucleoside analogues. But, this particular combination seems to be helpful. I think people should start saquinavir and ritonavir simultaneously to reduce resistance and mutations. (Check with your physician about combining protease inhibitors, at least 3 known PWA's died of renal failure on this combo.) I follow patients very closely. Careful, good medical management & early treatment of major/minor complications helps to maintain stability. Reinforcing a respectful & trusting doctor/patient relationship is an essential key to successful treatment of this difficult disease.
This article was provided by Women Alive. It is a part of the publication Women Alive Newsletter.