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This Month in HIV: A Podcast of Critical News in HIV
  

This Month in HIV: Breaking HIV/AIDS Research From CROI 2007

March 2007

This podcast is a part of the series This Month in HIV. To subscribe to this series, click here.

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Structured HIV Treatment Interruptions

That's a really good point. I have a couple more questions, and then we have to end. Treatment interruptions. We learned last year that treatment interruptions can really be dangerous. But you probably know a lot of people who have, or want to, take a treatment interruption. Anything at CROI that weighed in on whether this is still considered a bad idea?

"The pendulum, I think, is starting to show that we may be moving again towards earlier treatment and continuous treatment, especially if we can find combinations of drugs that are not as toxic as the ones we used to have."

Yes. This is another area of a lot of controversy. I think we have a lot of controversies in AIDS, I think. There was a study that actually followed -- well, you know, the SMART [Strategies for Management of Antiretroviral Therapy] study -- there was a sub-study there that looked at cardiovascular disease in those that continued therapy uninterrupted versus those that interrupted therapy. They found a slightly increased incidence of cardiovascular disease in those that interrupted therapy. Some people have a hypothesis ... that maybe inflammatory markers are reduced while on therapy. Once we stop therapy, inflammation has to increase, and maybe that affects the cardiovascular system.

That's only a theory. I don't think anybody has really proven it. But the SMART sub-study presented at CROI showed some trends that may indicate that starting and stopping therapy may not be very good for the cardiovascular system. That's definitely one set of data that tends to point towards people not stopping therapy.

Another potential disadvantage of treatment interruptions is that one or two studies have shown that people tend to be more infectious to others once their viral load increases. For instance, you are on treatment; you're doing well. Your viral load is undetectable. You're doing okay. Then, for any reason -- you probably went on vacation or encountered a side-effect related issue -- you stop therapy. You're still playing unsafe sex. You're not protecting yourself and others. Your viral load goes up, and you could infect somebody else a lot easier, or more easily, than if you were treated and had undetectable viral load.

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So that's another issue that -- there's a public health issue that we should address, too, for treatment interruptions. Not everybody should be on continuous treatment. I don't think we should even be preaching, or thinking, about that, especially if you have good numbers and low viral load. But definitely the pendulum, I think, is starting to show that we may be moving again towards earlier treatment and continuous treatment, especially if we can find combinations of drugs that are not as toxic as the ones we used to have. I think we're almost there. I think there's some more work to be done. But we're getting there.

Finally, everybody newly diagnosed wants to know what their chances of living a normal lifespan are. There was a bunch of interesting studies on the topic at CROI. Did you get a chance to see them?

I read them. I read those papers, but I try not to think about it too much because I've been positive for this long and I am getting old, too. But, hey, I want to live even longer. I love my life. Telling people you may have 20 more years, or 25 more years -- that can impact them psychologically.

However, I'm starting to see more and more studies on this subject. This is all modeling stuff -- data that comes from modeling. I think we have to be very careful in how we analyze it. There's some data from a Swiss cohort that shows that most of us are probably going to have a full life -- over 25, 30 years. [Click here to read coverage of the study.] Look at me. I have been positive for 24, 23 years, and I've had an undetectable viral load only for six months out of all those years.

But you're a miracle story.

"Control things that are within your control, I tell everybody. ... Not smoking. Eating more healthy. Exercising. Taking your meds on time. Probably doing some meditation, practicing yoga, reducing your stress, doing support groups, getting involved."

Yes. But I'm trying to say: If you have an undetectable viral load, you are taking care of yourself and your T cells are still within range -- even if you have low T cells, but your viral load is undetectable, you're taking care of yourself, taking your vitamins, working out, managing your stress, definitely -- there's no compelling reason why we should not be thinking that we're going to live to be old men and women.

If we don't smoke and exercise ...

Yes. On the other hand, we might have cancers or cardiovascular problems that are due to genes, bad genes -- so we can always blame our parents.

There was a study -- I don't know if it was presented at CROI -- that showed that heart disease in people with HIV is mainly caused by lifestyle factors. The people who were getting heart disease were people who would have gotten heart disease, even without HIV. They were overweight, they didn't exercise and they smoked. They were just high-risk people.

We also have to be very careful when we say things like this, too, because there are people who are actually taking care of themselves that are still struggling with their health. So I try to be careful. But, yes. Control things that are within your control, I tell everybody. What's within your control? Not smoking. Eating more healthy. Exercising. Taking your meds on time. Probably doing some meditation, practicing yoga, reducing your stress, doing support groups, getting involved. Especially treating depression. I mean, depression has been really linked to lack of adherence and lowering immune function. You know, it takes a lot of work to stay healthy. I tell people it's a lot easier just to give up and die than it is to get the discipline that it takes to take care of yourself. That's what HIV is. HIV is a wake up call to get disciplined. If you don't have discipline, you better get it.

Being vigilant about your health -- finding out the latest research, doing things before your doctor tells you to do them.

Yes. Use the Internet. Really get involved with Internet groups. Read a lot. Yet be very careful. Don't stress yourself out so much when you read things. Get some input from your doctor. And have a little faith, you know.

Well, this has been great, Nelson. Thank you so much.

Well, thanks a lot for giving me the chance to speak on behalf on patients and activists. Thanks a lot.

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Copyright © 2007 Body Health Resources Corporation. All rights reserved. Podcast disclaimer.

This podcast is a part of the series This Month in HIV. To subscribe to this series, click here.


  

This article was provided by TheBody.com. It is a part of the publication This Month in HIV.
 

 

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