should i be on meds?

[bbtwink]

I've been poz for like 7months now should I be taking meds or can I just eat super healthy? I just found out a montho ago that I was poz but my doc said I've been poz for like 7months I don't want to take meds though but I can still be off meds and healthy right?....

[Guest JizzDumpWI]

Short answer, probably yes. But ask your ID (hiv) doc. What did he say about your cd4 and vl?

[bbtwink]

He said he didn't want to put me on meds but that it was up to me

[GermanFucker]

The simple truth: 99% of all poz men will have to go on meds at some point in time in order to survive. Eating healthy is not a substitute for that (one should do that anyway as it is always a benefit to your general wellbeing). WHEN you will have to start meds depends on your body's reaction to the virus. Some need to go on meds after 5 months, others after 5 years, only your doctor can tell you which category you belong to. Many say that with all the new regimens starting meds early will help you in the long run, so you can always start taking them before you absolutely have to. That is your decision. But it's not recommendable to wait beyond the point where your body can't put up enough of a fight. So discuss your options with your doctor.

Eating healthy, sports, yoga etc. are allways good, but the only thing proven to fight the virus itself are antiretrovirals. There is no alternative to starting meds at some point in time (at least for 99% of all poz men).

[PhoenixGeoff]

Previously, the CDC here in the US had recommended going on meds when your CD4 count drops below 350 IIRC. More recent research seems to show that your long-term health tends to be better the earlier you start taking your meds.

As others have pointed out, the first step here should be to have your CD4 count, viral load and a genotype test done (the genotype test will identify if the particular strain of virus you've got is resistant to any drug classes). Your doctor will probably do a bunch of other blood tests as well to check for possible co-infections like Hep B or C (certain HIV meds can also have an effect on Hep , liver function (if you have liver problems, that excludes taking certain meds that are hard on the liver), etc., etc. Basically, get used to having a bunch of vials of blood drawn whenever you go in for a checkup.

So make sure you and your doctor have all of that information first.

My suggestion would be that if your CD4 count is above 500 (i.e. in the normal range), you can do without meds for now, but continue getting your numbers checked every three months.

If your CD4 count is between 350 and 500, you might want to consider starting meds, even if it's a bit early. Remember, there are side effects you will likely have to work through and getting yourself on a regimen can sometimes be difficult. Easiest to do that if you don't have any other problems to worry about. And research suggests that you'll likely have more success down the road. On the other hand, if you're not psychologically ready to start treatment (it took me about a year), then you can feel free to take a break. Keep monitoring things every three months though.

If your CD4 count is 350 or below, I'd recommend starting treatment immediately.

The US government has a pretty decent site here, if you want more info.

[Pig Bottom]

10s of thousands of men in the 80s ate healthy and died of aids. Eating and exercise won't stop the virus from replicating, only medication will.

[bearbandit]

The US guidelines give 500 as the CD4 count at which to start meds, though of course there are exceptions to this, such as if you're in a relationship with someone who doesn't have HIV, in the UK at least, they'll let you start meds at 800 or 900.

The things you need to know from your doctor are (a) your CD4 count and ( your viral load. Before you start meds, the CD4 count is the important measure (think of it as a measure of vulnerability to other infections: for example I only ever get thrush in my throat if my CD4 dips below 300). After you've started med the viral load becomes more important as it's the amount of free virus in your blood attacking CD4 cells that's important. The aim of medication is to get your VL down to undetectable (in practice between 40 or 50 copies per millilitre of blood in the UK). The earlier you start this process, the more likely you are to be successful in getting to undetectable.

Also worth bearing in mind is the fact that the healthier you are when you start treatment, the more likely you are to stay that way. A number of the most common combinations are available in a single pill - how many seconds does taking a single pill take out of your day? The downside is that that/those pill(s) must be taken every single day, which some people find they can't deal with as it's a daily reminder that they've got HIV. A lot of guys get their jocks in a knot about side effects: they're not compulsory. About nine out of ten people don't experience any side effects to their medication.

Get your numbers from your doctor and do some research around the HIV sites. Ask friends who are on treatment. Remember that HIV's little trick is that not only does it lower your immune system, leaving you vulnerable to opportunistic infection like thrush and worse, but it can cause damage to other systems in your body.

I've stayed as objective as I can for the above. This is personal opinion: hit the little bastard hard and fast. Right now it's starting its mission of depleting your immune system, causing damage in your gut, skin, brain etc. The sooner you start fighting back the sooner you get it on the run and can start looking at an average life-span again (and healthy eating/lifestyle/exercise will help but it's in the nature of the beast that the human body needs help to live once HIV has taken up residence). The best of luck to you...

[JerryGumby]

if / when you do go on meds - I've one bit of advice - if you are on them take them as instructed and try and not miss doses - basically either take them as you should or stop taking them all together. Its the missing doses people that get into trouble and gain resistance. Getting use to side effects can take some time -- and DO give them some time but there are so many combinations available now - eventually you will find one that not only works but few side effects. At one time I was taking up to 37 pills a day, 5 meds for hiv, and 2 for side effects that I was suffering from. But the choice seemed to be side effects or death. Eventually I found a 4 drug combination 5 pills a day that not only has kept me undetectable but no noticeable side effects. And there is some good advice in the above posts!

[TigerMilner]

Your doctor gave the same advice that the first two doctors I saw did. It makes me think he is not up to date. All the new research and articles indicate that there is no advantage to waiting and every advantage to starting at the earliest possible time. I was 5 months into it when I started. I've been undetectable for a year this month. I realize a lot of guys fantasize about bug chasing and gift giving but the reality is it's your body and this virus is working against you right now. It is trying to kill you. Why on earth would wait to fight back? I think you should see another doctor, and be sure he is an Infectious Disease Specialist. Nothing hot about dying.

[bigdick4you]

Short answer, probably yes. But ask your ID (hiv) doc. What did he say about your cd4 and vl?

I have waited 20+ years as my viral load and cd4 were fine. It was only when I went under 350cd4 that my doctor recommended taking them. I would personally avoid going on meds till absolutely necessary.

[slobbtop]

Some new research shows that if you get on meds within the first 6 months to a year of infection that after a few years on meds some people become what is called a long term non-progressor, which means that the infection does not get worse with out meds. All the medical research out now says the sooner you get on meds the better. Some studies show that if you get on meds within the first year there is almost no decrease in life expectancy.

[marcoPolo]

Your doctor gave the same advice that the first two doctors I saw did. It makes me think he is not up to date. All the new research and articles indicate that there is no advantage to waiting and every advantage to starting at the earliest possible time. I was 5 months into it when I started. I've been undetectable for a year this month. I realize a lot of guys fantasize about bug chasing and gift giving but the reality is it's your body and this virus is working against you right now. It is trying to kill you. Why on earth would wait to fight back? I think you should see another doctor, and be sure he is an Infectious Disease Specialist. Nothing hot about dying.

True, but you don't want to kill or destroy all the weak hiv virus population and be left with the Spartans of hiv.

[bearbandit]

True, but you don't want to kill or destroy all the weak hiv virus population and be left with the Spartans of hiv.

No, you want to hit the Spartans of HIV first so the strong ones are out of the way, and then it's a mopping up operation forcing what HIV is left in the body into its hidey-holes. You keep taking the meds every day to make your bloodstream and cum toxic places for the virus.

[PhoenixGeoff]

Your doctor gave the same advice that the first two doctors I saw did. It makes me think he is not up to date. All the new research and articles indicate that there is no advantage to waiting and every advantage to starting at the earliest possible time. I was 5 months into it when I started. I've been undetectable for a year this month. I realize a lot of guys fantasize about bug chasing and gift giving but the reality is it's your body and this virus is working against you right now. It is trying to kill you. Why on earth would wait to fight back? I think you should see another doctor, and be sure he is an Infectious Disease Specialist. Nothing hot about dying.

I agree, not going on meds because you want to feel all edgy and shit about how you don't give a fuck about AIDS is stupid. And yeah, when it comes to fantasizing about getting infected or infecting someone else (especially without their knowledge) with a deadly disease, well perhaps we might suggest that maybe, just maybe, there are certain fantasies that should not be indulged.

But there are solid reasons for delaying starting meds if you are otherwise healthy (and by healthy, I mean having CD4 counts in the normal range).

Taking HAART isn't like taking an aspirin. Many of the meds can have potentially serious, even potentially deadly side effects. We're talking side effects that can leave you in a permanent state of low-grade nausea and nasty diarrhea. Or fuck with your head and make it impossible to sleep at night or concentrate during the day. Or rob you of any energy to go out and get anything done. And that's just the stuff that I've personally experienced at one time or another (and I count myself as someone who's gotten off pretty lightly).

Some can be complicated to take, especially if your life is chaotic. For instance, I have a once-a-day regimen. Simple, right? Except my job has me working and sleeping at a variety of times depending on the work situation. Oh, and I've not supposed to take it with a high-fat meal (like damn near everything they have in truck stops). And it might cause some of that insomnia I mentioned. Now it's not so simple anymore.

Now imagine doing that if you have a drug problem. Or an unstable home life. Or don't have much of an income. Any or all of those situations might mean that starting meds earlier might cause problems with adherence which can leave you worse off than you were before. Better by far to deal with the life stuff first, get yourself somewhere stable, then go on meds, if you have that luxury.

And then there's the issue of long-term health problems that can accumulate over years of taking the meds. Tenofivir is commonly prescribed as a first line medication. But as bearbandit pointed out on another thread, it can have serious cumulative risks to your kidneys that persists even after its use is discontinued. Other medications place a huge amount of strain and wear and tear on your liver. Will they keep HIV from killing you? Absolutely. But over the long haul, they might themselves end up causing problems too. Why not delay that as long as possible?

The decision to start meds is a personal one. All anyone, including doctors, can do is make recommendations. The choice is ultimately yours. You need to do the research, consider the risks and make the best decision you can based on the available data.

[wood]

Previously, the CDC here in the US had recommended going on meds when your CD4 count drops below 350 IIRC. More recent research seems to show that your long-term health tends to be better the earlier you start taking your meds.

As others have pointed out, the first step here should be to have your CD4 count, viral load and a genotype test done (the genotype test will identify if the particular strain of virus you've got is resistant to any drug classes). Your doctor will probably do a bunch of other blood tests as well to check for possible co-infections like Hep B or C (certain HIV meds can also have an effect on Hep , liver function (if you have liver problems, that excludes taking certain meds that are hard on the liver), etc., etc. Basically, get used to having a bunch of vials of blood drawn whenever you go in for a checkup.

Bingo. I have had two friends who tested poz recently and they both went on medication almost right away. IMO that is the best way to do it. the old school of thought was that you could go a while before needing medication, however it has been shown that the virus can do a significant amount of damage in that time, and it may be difficult to rebuild your immune system if you go even to CD4 counts of 350. Additionally, when you are immunocompromised for any reason you are much more likely to get any number of infections.