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I started HAART 30 days after initial HIV infection in 2011 while at the trailing edge of the acute phase. And I wish preliminary data of the START study even without conclusions. I was confident I made the right choice to start so soon based on the literature I could find (mostly online from sites like this). The side effects are not bad but do affect quality of life - the tiredness, skin rash, llipodystrophy. . So many articles on why to start meds early; almost none on why not to.
Several years ago the federal government and states were grappling with the high cost of treamtent. Delaying treatment was considered as a cost saving measure. I am so fortunate I was not told (as many of my friends were)that I could wait until my CD4 fell to 300 to begin treatment. I knew this was ridiculous to wait that long. I am so glad I went on meds at 1100 CD4. I am eternally grateful as I have been poz 22 years now with current CD4 of 1157.
There is a certain benefit, from early treatment, that the article does not discuss. I am referring to the public health benefit of early treatment. If one is treated early, and one's viral load is knocked down to undetectable levels, one's semen may also have much less HIV and one will be much less infectious. And so we help not only ourselves but also our brothers when we adhere to early treatment.
It is interesting to note that the decision to move to 200/microlitre (as noted in the post) was led by the WHO. In their 2002 guidelines they justified this as follows "While beginning therapy before the CD4 cell count falls below 200/mm3 clearly provides clinical benefits, the actual point above 200/mm3 at which to start therapy has not been definitively determined."
Delaying treatment has to do with one "Pride" (thinking they are a "special" case that HIV can't beat them and also many thinking that because they have not progressed to full blown status that they are "immune". Its all tragic thinking). People must realize the virus replicates by the billions and eventually it will over come the immune system IF you are not given the weapon to fight it. GET ON THOSE MEDS! (but stop smoking and meth as well) and EAT right, which so many gay men won't do.
2/3 of HIV+ people in the US aren't even undetectable. It seems that every year, treatment is harder to access. Regardless, most HIV+ don't present with cd4s above 500. Of those who do, most will drop below that threshold in just months. Poz should not distract from bigger problems by splitting hairs on impractical issues. When articles like this are published, this magazine appears out of touch and unconcerned with the welfare of its readers. There are no words for the revulsion I feel
Correction to my comment (the first on the list). Where I wrote "Within one month of starting treatment your CD4 cell count will fall by 100 times" should, of course have been "Within one month of starting treatment your VIRAL LOAD will fall by 100 times". Apologies.
Michael
There aren't arguments against starting meds because the benefits outweigh the costs. As for "lipodystrophy", this is unusual. Lipoatrophy is almost unknown these days, and claims of lipohypertrophy are questionable. "HAART" are typically the same meds this magazine advocates for HIV-, with a gentle integrase inhibitor added. There's no logical, compassionate, utilitarian reason to advocate PrEP without demanding HAART for all. The inconsistency is shocking & validates our worst suspicions.
March 21, 2015 • Collinsville, IL