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Monday, November 23, 2009
Thursday, November 05, 2009
When to Start HIV Treatment
When should I start treatment?
It remains unclear when the best time to start therapy is. The “best” time for one person may not be the “best” time for another. There’s also much debate about which drugs to start with and in what combinations. Several factors — including HIV levels, CD4+ counts as well as how you feel about therapy — are important to consider when deciding if and when therapy is right for you.
Many questions can also be considered when making these decisions. Should treatment be used immediately when you first learn you have HIV? Should therapy be saved until changes occur in your immune health? Should it be saved until there’s a higher viral load, or until symptoms of HIV develop?
In deciding when to start, switch or change HIV therapy, three medical factors are generally considered:
•What’s happening with measures of your immune health (particularly CD4+ counts)?
•What’s happening with your general health, like symptoms of HIV disease or recurrent conditions despite treatment?
•What’s happening with your HIV levels?
Deciding to begin treatment is not solely a medical matter. Other factors must be considered, including:
•Your feelings about therapy;
•Your readiness and willingness to take therapy, including taking it as prescribed;
•The impact that therapy may have on your quality of life;
•Possible side effects;
•How long therapy can last, and whether or not there will be new and better drugs to replace them if or when they fail; and,
•Your risk of disease progression in the short-, middle-, and long-term.
When is the right time to start?
Some believe there can be no single, right answer to the question of when to start. Some researchers and doctors believe that nearly everyone with HIV — regardless of their CD4+ counts, viral loads or symptoms — should be treated. Some believe people should start therapy only when their CD4+ counts consistently read below 350. Others believe that only people with symptoms of HIV disease should consider therapy.
One note of agreement is that most researchers and doctors believe that the decision to start should be guided by both CD4+ cell counts and overall general health. Increasingly, information suggests that CD4+ counts provide the most accurate tool to monitor the risk of HIV disease progression.
The most commonly used viral load tests are Roche’s RT-PCR (polymerase chain reaction test, called Amplicor HIV Monitor Test), Chiron’s bDNA (branch DNA test, called Quantiplex) and Organon Teknika’s NASBA (nucleic acid sequence based amplification test, called NucliSens). When possible, it’s best to use the same lab and same test every time. For example, RT-PCR results are consistently higher than those obtained with bDNA. Similarly, different labs might get somewhat different results when running a CD4+ count.
It remains unclear when the best time to start therapy is. The “best” time for one person may not be the “best” time for another. There’s also much debate about which drugs to start with and in what combinations. Several factors — including HIV levels, CD4+ counts as well as how you feel about therapy — are important to consider when deciding if and when therapy is right for you.
Many questions can also be considered when making these decisions. Should treatment be used immediately when you first learn you have HIV? Should therapy be saved until changes occur in your immune health? Should it be saved until there’s a higher viral load, or until symptoms of HIV develop?
In deciding when to start, switch or change HIV therapy, three medical factors are generally considered:
•What’s happening with measures of your immune health (particularly CD4+ counts)?
•What’s happening with your general health, like symptoms of HIV disease or recurrent conditions despite treatment?
•What’s happening with your HIV levels?
Deciding to begin treatment is not solely a medical matter. Other factors must be considered, including:
•Your feelings about therapy;
•Your readiness and willingness to take therapy, including taking it as prescribed;
•The impact that therapy may have on your quality of life;
•Possible side effects;
•How long therapy can last, and whether or not there will be new and better drugs to replace them if or when they fail; and,
•Your risk of disease progression in the short-, middle-, and long-term.
When is the right time to start?
Some believe there can be no single, right answer to the question of when to start. Some researchers and doctors believe that nearly everyone with HIV — regardless of their CD4+ counts, viral loads or symptoms — should be treated. Some believe people should start therapy only when their CD4+ counts consistently read below 350. Others believe that only people with symptoms of HIV disease should consider therapy.
One note of agreement is that most researchers and doctors believe that the decision to start should be guided by both CD4+ cell counts and overall general health. Increasingly, information suggests that CD4+ counts provide the most accurate tool to monitor the risk of HIV disease progression.
The most commonly used viral load tests are Roche’s RT-PCR (polymerase chain reaction test, called Amplicor HIV Monitor Test), Chiron’s bDNA (branch DNA test, called Quantiplex) and Organon Teknika’s NASBA (nucleic acid sequence based amplification test, called NucliSens). When possible, it’s best to use the same lab and same test every time. For example, RT-PCR results are consistently higher than those obtained with bDNA. Similarly, different labs might get somewhat different results when running a CD4+ count.
The challenges of HIV therapy
The challenges of therapy
Unless HIV replication is controlled, trying to rebuild immune health will ultimately fail — at least most of the time. Although using therapy hinders HIV from replicating, it does not eradicate the virus from your body. Many scientists fear that it’s not possible to fully eliminate it. Others don’t share this pessimism, pointing to newer and better drugs as well as an ever-growing understanding of HIV disease and its effects on the immune system. Over time, HIV can mutate or change enough so that it’s no longer fully blocked by these drugs.
This process is called viral resistance and it can happen to some degree with all HIV drugs. However, keeping HIV under control lengthens a person’s life, and it may be possible — with truly effective therapy — to live out a normal lifespan despite HIV. Abundant evidence shows that using potent HIV therapy has dramatically lowered death rates. It has also increased life and quality of life for people living with HIV.
However, the drugs are not without their risks of side effects. When deciding on therapy, the possible short- and long-term side effects must be weighed against possible short- and long-term benefits, particularly as you consider when to start. There’s little research on using HIV drugs in the earlier stages of HIV disease. Many, if not most, people don’t have to decide this immediately after learning they have HIV.
Assessing your risk of disease progression and making decisions that you feel comfortable with are important parts of building a successful long-term HIV strategy.
Why use anti-HIV therapy
When you’re first infected with HIV, high levels of HIV replication often occur with flu-like symptoms and a decline in the number of CD4+ cells. CD4s are key cells in your immune system that maintain and direct responses against disease. They are also commonly used to measure your immune health.
Without using HIV therapy, your immune system dramatically but incompletely suppresses the virus. In most cases, CD4s return partially toward normal levels and people usually regain good health for many years. Yet, during this time an aggressive battle is waged daily between your immune system and HIV. Over time, the immune system becomes overwhelmed by HIV’s rapid and constant activity.
The relationship between your HIV levels and risk of disease progression is complicated. An influential study by John Mellors found a solid relationship between HIV levels and risk of death over time. Other research suggests that CD4+ counts better predict the risk of disease progression. However, it is well established that reducing HIV levels typically leads to a stronger immune system and better health.
Considering these points, it makes sense to slow down or stop HIV replication as much and for as long as possible. All approved HIV drugs significantly reduce HIV levels, and they almost always cause some rise in CD4+ counts. Lower viral loads and higher CD4+ counts indicate some improvement in your immune system.
Unless HIV replication is controlled, trying to rebuild immune health will ultimately fail — at least most of the time. Although using therapy hinders HIV from replicating, it does not eradicate the virus from your body. Many scientists fear that it’s not possible to fully eliminate it. Others don’t share this pessimism, pointing to newer and better drugs as well as an ever-growing understanding of HIV disease and its effects on the immune system. Over time, HIV can mutate or change enough so that it’s no longer fully blocked by these drugs.
This process is called viral resistance and it can happen to some degree with all HIV drugs. However, keeping HIV under control lengthens a person’s life, and it may be possible — with truly effective therapy — to live out a normal lifespan despite HIV. Abundant evidence shows that using potent HIV therapy has dramatically lowered death rates. It has also increased life and quality of life for people living with HIV.
However, the drugs are not without their risks of side effects. When deciding on therapy, the possible short- and long-term side effects must be weighed against possible short- and long-term benefits, particularly as you consider when to start. There’s little research on using HIV drugs in the earlier stages of HIV disease. Many, if not most, people don’t have to decide this immediately after learning they have HIV.
Assessing your risk of disease progression and making decisions that you feel comfortable with are important parts of building a successful long-term HIV strategy.
Why use anti-HIV therapy
When you’re first infected with HIV, high levels of HIV replication often occur with flu-like symptoms and a decline in the number of CD4+ cells. CD4s are key cells in your immune system that maintain and direct responses against disease. They are also commonly used to measure your immune health.
Without using HIV therapy, your immune system dramatically but incompletely suppresses the virus. In most cases, CD4s return partially toward normal levels and people usually regain good health for many years. Yet, during this time an aggressive battle is waged daily between your immune system and HIV. Over time, the immune system becomes overwhelmed by HIV’s rapid and constant activity.
The relationship between your HIV levels and risk of disease progression is complicated. An influential study by John Mellors found a solid relationship between HIV levels and risk of death over time. Other research suggests that CD4+ counts better predict the risk of disease progression. However, it is well established that reducing HIV levels typically leads to a stronger immune system and better health.
Considering these points, it makes sense to slow down or stop HIV replication as much and for as long as possible. All approved HIV drugs significantly reduce HIV levels, and they almost always cause some rise in CD4+ counts. Lower viral loads and higher CD4+ counts indicate some improvement in your immune system.
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