Friday, 16 June 2017

Immediate HIV treatment? - same day as diagnosis?

I've just filled out an online survey from Positive Life regarding my thoughts on starting HIV treatment on the same day as an HIV diagnosis.

It sounds good in theory, but as we're human beings we're all different. Look at the problems I had with Truvada and Naprosyn which caused an allergic reaction and acute kidney failure. I nearly carked it. Indeed the kidney specialist told me when I was discharged from hospital that on presentation to Emergency I'd have been about 48 hours from death had I not turned up there.

They also tried Kaletra after stopping the Truvada which caused my heart to just about stop and I nearly carked it again. They found me at home on the bed nearly dead with a very weak pulse. I spent three days on a respirator (I don't remember that BTW) whilst nobody knew if I was going to live or die. The hospital staff even inquired to a friend of mine visiting at the time as to my wishes about pulling the plug. I eventually woke up but the lack of oxygen had further damaged my kidneys as well as some brain damage. Upon waking I thought I was at home for example, and I was wondering what all these hospital people were doing there. They had my hands tied to the bed so I wouldn't pull out the central line. I remember thinking how unfair that was!

My point is that caution should be used in prescribing HIV drugs. Yes today's drugs are a marvel of modern science and work well, but diving in blindly head first seems rather dangerous to me. There should be blood cultures done to find out about possible allergies for example. This is what my HIV GP did with me when I went back on the meds after a two year break to give my kidneys time to recover. I've had no problems since then and have been undetectable for years.

The time lag between diagnosis and starting treatment is shortening. Some of us can remember a time when the Australian HIV Treatment Guidelines recommendations were to wait until your CD4 count was 350 or below. History however shows us that the International and Australian HIV Treatment Guidelines have been incrementally revised upward to higher and higher CD4 counts. Firstly it was treat below 350, then 500, and now the recommendation is to start at any CD4 count. Research is increasingly showing that treatment commencement very soon after diagnosis (i.e. immediate) is recommended as your best course of action, not only for your health, but also to prevent the transmission of HIV to your sexual partners.

 So, what’s the difference between immediate and early treatment? ‘Early’ treatment is usually defined as starting treatment within six months of diagnosis. The definition of ‘immediate’ is less clear. Basically, it’s initiating treatment as soon as possible after diagnosis, and ideally within two to four weeks. There’s a number of important issues for people starting treatment to consider: tests to determine what drugs work best for you and not produce allergic reactions; the results of your HIV viral load and CD4 cell counts; tests to identify your predisposing risks factors for developing side effects from the drugs; working out the best drug combination to start on; and allowing enough time to get your head around the diagnosis. Positive Life