Of course, the decision to start HIV therapy is a personal one, taking to account current medical information, the reccommendation of your health care provider, and your own ablility to stick with a pill taking regemin for the rest of one's life.
The two main laboratory factors are your viral load and CD4 or T-cell count, used as an indicator of your current level of immune function and the speed at which the disease progresses. When I was at the International AIDS Conference in Geneva a researcher used a train approaching a broken bridge as a metaphor for the two numbers. When the train (a metaphor for a person living with HIV) reaches the broken tracks, they are at a point more suseptible to illness; in terms of a CD4 count, that would be around 200 or less, when one becomes at risk for opportunistic infections. The higher the CD4, the further the train is away from the edge. The speed of the train is the viral load; the higher the viral load, the faster you move to the edge.
Once someone begins HIV therapy, the train slows down, stops, then begins to back away from the edge. Since effective therapies have been only been around for fifteen years, we don't know what the long-term effects will be. If missed doses didn't lead to treatment failure and if the drugs were side-effect free, the CDC would probably recommend that everyone with HIV should start on meds. With our current knowledge, the recommendation is to start on meds when the CD4 count drops below 500. In the EU, their more cautious recommendation is to start at 350.
But is it better to start sooner or later? In the April 19, 2011 issue of The Annals of Internal Medicine researchers compared data from multiple studies in the United States and Europe. As it turns out, significantly reduces HIV patent's risk of progressing to AIDS. In an accompanying editorial, the authors point out that in addition to fewer AIDS-defining illnesses, starting more people on therapy sooner will reduce the number of new cases of HIV. In addition to the personal health benefit, starting early on HIV meds benefits the community.
Thinking back to the early days of the epidemic--before medications and HIV testing--they way we slowed transmission was to protect ourselves and protect each other. It seems that caring for the community at large is a good idea whose time has come again.
Comments