Izzy: I'll bite. I don't contribute much these days but have followed this subject (HIV) for over a decade.
>>if I told you that you were HIV positive and you were asymptomatic, what, if any, treatment would you want?<<
I would want an viral RNA test and other blood work to show the current state of my immune system, in order to establish a baseline by which to measure future progress or regression. I would then get informed about treatment options, finding a physician who is knowledgeable/specializes in HIV. I would decide on my course of treatment based on those results, physician advice, and after reviewing such information as that provided on-line by GMHC, AIDS Treatment Network, Project Inform, and JAMA. This link has a comprehensive list of places to start:
ama-assn.org
Of course, all of this info is available in paper form to anyone who calls and asks for it.
>>If you were to take a PI, would you insist on taking only Viracept, even tho' your doctor suggested another PI drug?<<
Almost all of the physicians I know offer their patients any medication they are willing and able to use as directed. With that in mind, I think Viracept is easier to manage 3x daily. Reported side-effects for Viracept are fewer in variety if not frequency, and much more tolerable in my view (diarrhea is easily treated by lomotil a/c everyone I know who uses it. Kidney stones are not.:-)
>>Do you think that by taking PI combo treatment early in the disease process (remember that there is no "cure" yet), do you think that you will remain asymptomatic for a longer period of time...?<<
Yes, I do. Everyone I know thinks this is probably true. There are studies going on at the present time. Preliminary results show that active intervention at or near time of acute infection, reduces the number of CD4 cells permanently destroyed by HIV, and that subsequent recovery of immune capability is greater than that of those who remain untreated.
I will put this another way: EVERYONE I know who did NOTHING a dozen years ago is dead. SOME of the people who did SOMETHING are alive. I would rather be alive and possibly wrong, than dead and irrelevant.
>>(remember that there is no "cure" yet)<<
There is no "cure" for diabetes, but that does not mean someone with diabetes should wait until they have an arm or leg lopped off to start using insulin.
>>Do you think... that you will not develop AIDS defining illnesses, including malignancies (cancer), for an indefinite period of time, that you will have a better quality of life for a longer time, and tha you will actually live longer?<<
Yes, of course. It seems to me this question was decided a long time ago. All of the medical evidence I have seen backs up this assumption.
>>There are physicians who have become HIV positive. What therapeutic approach do you think that they usually take?<<
Whatever they are most comfortable with or can tolerate :-). Seriously, all of the ones I know have used the most proactive treatment they could find to reduce the viral load/raise or maintain CD4 cell counts for as long as possible.
>>It is my impression that some people, who fear that they may be HIV +, do not get testing done because the results are not always anonymous and confidential.<<
After 18+ years, I would hope that people would know that almost everyone who waited until they had a symptom to find out is a fool, if they are, in fact, still alive. I can think of a dozen places where anyone could walk in and get an anonymous test and result, most for free.
>>In addition, the resultsof HIV testing ("Privacy Act") are not as confidential as one may think since too many people sign medical release forms without reading what they are authorizing (eg., Medical Information Board, insurance companies, etc.)<<
If it is a choice between treatment & living vs. avoiding embarrassment but suffering an ugly death, I choose the former every time. Compared to a dozen years ago, the amount of hostility and poor treatment is negligible. Very few people in America do not know someone with HIV or someone who died from its complications. It is hard to hate someone you know and love :-). As for releasing HIV information: the last time I checked it still required a form separate and distinct from the average medical release form.
>>What about HIV test kits that can be bought in the drug store and can be mailed somewhere for testing? Are these results guaranteed to be confidential? Would you do such a test?<<
No, I wouldn't, but if I did there is nothing to stop me from using any name I want and having the results mailed anywhere I want, precluding personal identification if that is what I am trying to avoid. If a mail-in test result was positive (that I was HIV+) I would run, not walk, to the nearest clinic for a confirmation.
>>I think that these are some of the reasons that there are untreated asymptomatic (and symptomatic) HIV patients.<<
Ten years ago, I might have agreed. Today, I do not. I think ignorance is the main reason. I think other leading reasons today include socio-economic status, lack of insurance, lack of access to informed care, and drug abuse.
One of the great problems in infection trends will be those who start treatment with these drugs but because of their lifestyle and circumstances are incapable of maintaining the regimen. In that case, it appears that they will, in fact, be worse off than if they never started. More importantly, their failure to follow through with treatment will undoubtedly give rise to new strains of the retrovirus completely resistant to any treatment.
These same people are more likely to not practice "safe sex," more likely to be promiscuous, and thereby spread even more virulent forms of the disease. This is the same health risk we have been examining since the onset of HIV. There appears to be no easy answer, save a "cure" which is not something that appears to be on our horizon.
>>It is just not a "perfect" system, IMO<<
I agree. There is no perfect system. I remember when British Columbia's provincial government refused its citizens access to AZT since it was a waste of money to treat someone with AIDS. So much for the compassionate Canadian system. Regards. |
