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9/1/13 10:01 P

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Oh, definitely! Totally agree! DH is on meds, but in my opinion he didn't start soon enough due to not great advice from his friend (an ER dr) and also due to false negative tests. It wasn't until he had a major secondary infection that he finally tested positive - and by then his CD4s were way low, viral load up in the 250,000s. It was crazy! Took a few years to get in a decent range for those numbers. Fortunately, his body is tough and he's doing well - but if the dr had said start the meds now, before you get these other horrible infections or complications, he might have done that. That was the point I was trying to make.

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9/1/13 3:12 P

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Where I live the new thinking is the earlier a person starts meds the better. While there is some lack of clarity about whether or not this will prevent or slow the generalized inflammation the virus causes ,there is something to be said for suppressing viral load as soon as possible since we know an undetectable viral load makes you less contagious. Certainly we know that the sooner we suppress the virus the longer our immune systems will stay healthy. If we continue to wait till damage has been done or we have a an AIDS related complication we are doing ourselves no favors. There are many new drugs on the market now which make compliance so much easier than it was in the eighties when I was diagnosed. With a little work you and your provider can probably find a regime that works for you without severe side effects.

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8/28/13 7:30 P
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You're right. A full explanation of the pro's and con's should be discussed instead of suggesting only 1 side.

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PHEBESS's Photo PHEBESS Posts: 32,002
8/28/13 5:26 P

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Hmmmm, interesting.

DH's dr friend told him that he could begin the meds any time - and that was back when many of the meds had horrible side effects. Problem is, DH waited until he had some major symptoms (and a neurologic secondary infection) before beginning meds (well, and it took that long for him to get a positive diagnosis, he had all those false negatives) - so that he ended up with some permanent damage.

I think maybe if more people knew that THAT was a possibility, they might begin treatment sooner. When a dr says not to worry, you can hold off on treatment, well, people believe that. If the dr says hey, you can get all kinds of other kinds of diseases that will leave you with problems for the rest of your life, so start these meds now, it kind of makes sense that more people would begin.

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8/28/13 10:56 A
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CD4s at Entry Into HIV Care Largely Unchanged in 20 Years

August 21, 2013

CD4s at Entry Into HIV Care Largely Unchanged in 20 Years

For people with HIV living in resource-rich nations, the average CD4 count upon entry into care has not seen an appreciable increase during the past two decades, aidsmap reports. As of 2011, that figure was 336. The finding has major implications for the current debate over the best timing for beginning antiretrovirals, implying that policies to start therapy at 500 CD4s rather than 350 lose their poignancy when so many HIV-positive people present themselves to care relatively late in the course of their infection.

Publishing their findings in Clinical Infectious Diseases, researchers from the United States and the United Kingdom conducted a systematic review of 44 studies, including data spanning from 1992 to 2011, on the CD4 counts when entering care of 169,000 people with HIV. The studies were largely from the United States and United Kingdom with a respective 18 and 11 between them.

In 1992, the average CD4 count upon entry into care was 307. By 2011, this figure rose to 336, for an increase of 1.5 cells each year. However, statistically, the CD4 level remained essentially unchanged, meaning any apparent differences could have been explained by chance. Furthermore, the proportion of those entering care late or very late reduced only slightly during the two-decade period, with a reduction of just 0.1 percent per year.

The authors wrote, “Our study findings indicate that the considerations of when to start [therapy] may be immaterial for the majority of patients who continue to enter care below any of the recommended treatment thresholds.”

In an accompanying editorial, Joep Lange, MD, a professor of medicine and head of the Department of Global Health at the Academic Medical Center at the University of Amsterdam in the Netherlands, wrote, “The finding that so little has changed with regard to time of presentation to HIV care in a period that saw dramatic improvements in HIV treatment and monitoring is astonishing.”

www.aidsmeds.com/articles/entry_care
_1
667_24405.shtml


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