My Issue With Early & Aggressive Treatment Of HIV...

[bearbandit]

Time and again we come back to the evidence that an undetectable viral load is at least the equal of condoms in HIV prevention. The pre-eminence of condoms in HIV prevention I believe dates back to the eighties when there was nothing to be done but to treat opportunistic infections. A different approach was taken with injecting drug users: harm limitation, hence the setting up of needle exchanges. A tacit admission that no HIV prevention campaign was going to keep an injecting user from their fix, so lets make it as safe as possible. I believe we're at a point in our knowledge of HIV drugs that it's time to drop the nanny-state "condoms on, boys, or else" to be dropped in favour of harm reduction.

PrEP probably isn't going to be very effective if you're putting it about a lot as you're liable to come across guys whose HIV is resistant to the drugs used, so it's better used for guys in serodiscordant relationship where the +ve guy's viral mutations (if any) are known. In the UK it's reckoned of the 91k of us who have HIV a full 26% don't know that they have it. HIV + no treatment in the vast majority of cases means a high viral load and thus high infectivity. I'd advocate a strong "test and treat" campaign and a return to the days of the seventies when it was routine to have a full STI check-up every three months, except this time including HIV, now that we know it exists. Part of this would have to contain the probably unwelcome message that the only people who know their HIV status for sure are those who have it: a negative test result simply means that no antibodies were found on such-and-such a date (witness the number of guys on BBRT who have on their profiles HepC- as of <date> and want to stay that way).

I know from personal experience that if I take a drug holiday my CD4 count will fall by about 75 a month while my viral load climbs. After my last drug holiday I ended up with a massive cryptosporidium infection: explosive diarrhoea four or five times a night is not only not pretty, it's expensive, exhausting and potentially fatal if you don't know how to rehydrate.

Even with full adherence the body's response can be chaotic, but I'd still maintain that it's better than the alternative: at my last hospital visit my CD4 had dropped from 460 to 264, though my viral load remained undetectable. Think of the CD4 count as my vulnerability to opportunistic infections and my viral load as your vulnerability to catching HIV from you should I leave a load in your ass.

Even though I'll sometimes use the language during sex, I have no wish to pass on my little passenger: the more HIV-unknown guys who test (doing so regularly) and go onto meds if their viral load is looking over the parapet, the safer we can keep barebacking. Don't forget: syphylis used to be a slow killer, now, should it turn up at your quarterly STI checkup it's just a rather painful injection in your glute.

[SpunkJunkyPissHound]

Be very careful about believing in that "undetectable" viral load, bearbandit. There is a very good chance that your antviral drugs are just fucking with the VL test, and NOT the viral load itself. One of the quickest changes that results from a drug holiday is the suspiciously fast viral load rebound. I don't know how long you've been with bug, but its important to remember that doctors are not scientists, and immunologists are far lest certain about viruses that pharmacudical manuafactures. 27+ years living with the bug, watchuing my friends die while their doctors live ( see: AZT and that EVIL initial interferon treatment for hep C) has taught me to be very suspecious of the" tests" and the good intentions of those who need to remain emotionally detatched.

[bearbandit]

The holiday was several years ago, and besides I use www.myhiv.org.uk to keep track of my numbers now (much less chance of losing them that way.My current VL is consistent with my previous experience. I probably seroconverted in 1980: I was fucking with a number of dutch guys then, all of whom had recent holidays in NYC or SF. Also turned up the the clinic with what in restrospect was fuck flu in 1980, but of course wasn't identified at the time. Finally diagnosed in 87. I acknowledge that horrible mistakes were made in inititial dosings of both the first fournd and the second round of drugs, but at that point we were fighting to live, or to put it more crudely dying to live.

I'm left with a number of disabilities from the early drugs, but at least I'm alive to bitch about them. My husband tried interferon as an immune modulator in the hope that an increased CD4 count would enable his own immne system to fight the MAI. Moderately successful. The we moved to another part of the UK where they weren't prepared to precribe interleukin and so got (after a great struggle we were prepared to take our rottweilers amd do a sit in protest at the Senedd in Cardiff to publicise John's case) Proleukin2 which was so hard on his liver that I believe that that's what killed him.

I'm fortunate in being in touch with several guys who have done considerable work in pharmacology and know I can always ask them questions about drugs. Be assured that I'm long used to the vagaries of my virus...

[TigerMilner]

Tony, I think you are smoking hot, and smart too. Double whammy.

[rawTOP]

The other day I was being a bit nerdy and watching TED Talks on my Roku and I came across this talk...

http://www.ted.com/talks/ben_goldacre_battling_bad_science.html

Basically, because of a profit driven business model, pharma companies regularly suppress research. In fact sometimes most of the research on some drugs is suppressed and only positive studies are released. As a result, evidence-based medicine is impossible since doctors are not given the information they need to make informed decisions.

So when a pharma company pushes early and aggressive treatment of a highly profitable drug (ARVs), when they push the idea that people who aren't sick should take those same drugs (PrEP), and when doctors blindly follow "thought leaders" who are being paid by those drug companies - you have to ask whether it's healthy for you to follow your doctor's advice and agree to aggressive treatment.