November 29, 2008

November 29, 2008
When Should You Start Taking HIV Medications?

Thanks for stopping by to check out what is going on in my life. Well we survived Black Friday and picked up more items for our children with HIV and AIDS.

It is Saturday and World AIDS Day is right around the corner. Here is Jacksonville, we sponsor events for a whole week so we have World AIDS Week. I will be ready for a week of rest after this next one is over.

One of the questions I get asked most often by people who have recently found out they are HIV positive is when do they have to start taking medications. So I decided to make it the topic for today.

When you should start medications require that several questions be asked. The most important of these questions would be what were your T-cell and viral load counts. These numbers along with personal health habits will help your health care provider determine approximately how long you have been infected.

Treatment soon after infection with HIV

It is recommended that you start HIV treatment if you are ill because of HIV or if your CD4 cell count is around 350.

Some doctors think that there might be benefits if people take a short course of HIV treatment soon after they are infected with HIV, in a period sometimes called primary infection. It is not yet known if using treatment in this way will mean that health is improved in the long term. It is therefore recommended that HIV treatment should only be used soon after a person is infected with HIV as part of a clinical trial. The results of a big trial are expected in the next year or two.

In the meantime, a study has been published that seems to show that there is nothing to be gained from taking HIV treatment soon after infection with HIV.

It involved about 1000 people. The researchers knew approximately when these people were infected with HIV, and just over 300 started HIV treatment within three months of this happening. These people took HIV treatment for varying lengths of time ranging from under six months to over a year.

Long term changes in CD4 cell count and viral load were compared between these patients and people who did not start treatment until later.

As would be expected, CD4 cell count increased and viral load fell when HIV treatment was being taken. But the researchers found that once treatment was stopped, the long term falls in CD4 cell count and increases in viral load were very similar between those who took early HIV treatment and those who did not.

The only people who seemed to get any benefit from early treatment were those who took anti-HIV drugs for a year or more. Their long term average CD4 cell count was higher than other patients.

On the whole, rates of HIV disease progression were similar between the patients who took early HIV treatment and those who did not. But the researchers did find one possible benefit from early HIV treatment lower rates of non-HIV-related illnesses.

The researchers point out that most of the early damage HIV causes to the immune system happens in the first couple of weeks after a person is first infected with the virus. They therefore think that as people in their study were starting treatment up to six months after infection, this was too late to be of any real value.

We will have a lot more information about the value of early HIV treatment when the results of bigger studies are published.

Early treatment and infectiousness

Viral load is very high soon after a person is first infected with HIV. This means that the risk of someone passing on HIV to a sexual partner is very high at this time.

Because successful HIV treatment leads to big drops in viral load, it reduces the risk of HIV being passed on by the person who is taking it. There is a lot of discussion about the use of HIV treatment as prevention.

Now researchers have calculated that diagnosing everyone with HIV and providing immediate HIV treatment would lead to big falls in the number of new infections. They also think that doing so would be highly cost effective.

They suggest that this approach is only suitable for countries like South Africa that have a very high HIV prevalence.

But HIV doctors also think that there might be a role for treatment in prevention. Current guidelines say that HIV treatment should be started when a person has a CD4 cell count around 350. But because HIV treatment can reduce the risk of HIV being passed on, one of the groups of people considered for earlier treatment is those who have an HIV negative partner.

Late diagnosis

Although it is recommended to start HIV treatment when your CD4 cell count is around 350, many people only find out they have HIV when their CD4 cell count is well below this level.

Late diagnosis of HIV is a major factor behind a lot of the HIV related illness and death seen in the United States. Now a study from a team of international researchers has provided further evidence showing that late diagnosis of HIV is associated with a high risk of death.

The research was conducted in Europe and Canada and involved 760 people who were already ill with an AIDS defining illness at the time their HIV was diagnosed. The average CD4 cell count of these patients was just 42, showing that they had a high risk of potentially life threatening infections.

A total of 125 people died.

There were also some encouraging results in the study. Over 600 people started HIV treatment, and the average period between diagnosis with HIV and starting treatment was a month. Starting HIV treatment led to good increases in CD4 cell count, with the average count one year after starting HIV treatment being 211. Most of the patients experienced good falls in their viral load.

This information makes a whole new argument for getting people to get tested. If we can send a man to the moon, I think we can get the truth out about HIV and AIDS in the United States and that everyone who are sexually active should get tested for HIV at least once a year if not twice.

Drop me a line and let me know what you think.

Wishing you health, hope and happiness.

Big bear hug,

Daddy Dab