Guest guest Posted September 21, 2006 Report Share Posted September 21, 2006 From another website--a query and my reply. Thoughts? >Early treatment provides short-term benefits according to some research >- http://www.aidsmeds.com/news/am20060919.html. >So is the mantra " hit hard and hit early " back now ? Seems like they >can't make up their mind about this. I think the data are fairly clear. Up to 24 weeks, it seems to give a bit of a bang for the buck that washes out after 48 weeks. Suggesting that the idea of treating at or around seroconversion with current ARV is probably NOT advisable. As a clinical plan or standard of care, this would be simply risking more people developing side effects or resistance earlier and possibly losing classes of drugs. By contrast, I think the evidence is growing that, if possible, ARV should be started around 300 CD4. A lot depends on other factors like patient willingness and commitment, rate of CD4 decline, CD4 percentage, viral load, clinical condition, etc. Meantime, EVERYONE with HIV can start with or continue to use a multivitamin. This has been shown to reduce progression and/or morbidity/mortality among those with AIDS. A multi is not only safe, it enhances health. And a multi early in disease may then further delay ARV debut. M. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 21, 2006 Report Share Posted September 21, 2006 The study you cite demonstrates that HIV antivirals are effective only if you take them. This is hardly as surprising or novel observation or conclusion. This would not have surprised you so much if you yourself had HIV and had experience with HIV antivirals. Insulin and virtually all other therapies are the same as HIV antivirals - they only work when you use them. This peculiar study compared HIV+ people who had not used antivirals to people who did use antivirals. After a year on antivirals the researchers had those who had been using antivirals discontinue them for half a year. Imagine their surprise when they discovered that after 24 weeks those who had previously been on antivirals still had lower viral loads when compared with those who never used antivirals. ly, that part surprises me too. But they were gratified when untreated HIV disease destroyed this immune advantage after more than a year off antiviral treatment. What does this mean? Obviously antivirals dramatically slow down the progression of HIV disease, but antivirals do not provide the immune system with any special protection against HIV when they are discontinued. They don't work like a magic charm. Is this an argument against early treatment? Absolutely not. If I take diabetics off their insulin, their disease returns. Is this an agreement for diabetic to not use insulin until diabetes has caused blindness, or the amputation of at least one limb? Well of course not. Only an insane person would make that argument. If a "diabetes expert" Bob suggested this, diabetics everywhere would be inclined to burn down Bob 's home. One of the tragedies of HIV disease is the inability of many to apply what we know from other diseases to HIV. They act as if HIV is a completely unknowable evil spirit like a bunch of cowering savages. This approach leads to death and destruction. There are some with HIV who have immune systems which maintain their T4 percentage above 30% and their T4 count above 500. These people will also typically have viral loads below 2,000 without antiviral treatment. For this population, which makes up less than 1% of the total number of people with HIV, non-treatment makes sense. But for everyone else with HIV, early treatment reduces both mortality (death) and morbidity (sickness from HIV). > > >Early treatment provides short-term benefits according to some research> >- http://www.aidsmeds.com/news/am20060919.html.> >So is the mantra "hit hard and hit early" back now ? Seems like they> >can't make up their mind about this.> > I think the data are fairly clear. Up to 24 weeks, it seems to give a bit > of a bang for the buck that washes out after 48 weeks.> > Suggesting that the idea of treating at or around seroconversion with > current ARV is probably NOT advisable. As a clinical plan or standard of > care, this would be simply risking more people developing side effects or > resistance earlier and possibly losing classes of drugs.> > By contrast, I think the evidence is growing that, if possible, ARV should > be started around 300 CD4. A lot depends on other factors like patient > willingness and commitment, rate of CD4 decline, CD4 percentage, viral > load, clinical condition, etc.> > Meantime, EVERYONE with HIV can start with or continue to use a > multivitamin. This has been shown to reduce progression and/or > morbidity/mortality among those with AIDS. A multi is not only safe, it > enhances health. And a multi early in disease may then further delay ARV debut.> > M. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 21, 2006 Report Share Posted September 21, 2006 The study you cite demonstrates that HIV antivirals are effective only if you take them. This is hardly as surprising or novel observation or conclusion. This would not have surprised you so much if you yourself had HIV and had experience with HIV antivirals. Insulin and virtually all other therapies are the same as HIV antivirals - they only work when you use them. This peculiar study compared HIV+ people who had not used antivirals to people who did use antivirals. After a year on antivirals the researchers had those who had been using antivirals discontinue them for half a year. Imagine their surprise when they discovered that after 24 weeks those who had previously been on antivirals still had lower viral loads when compared with those who never used antivirals. ly, that part surprises me too. But they were gratified when untreated HIV disease destroyed this immune advantage after more than a year off antiviral treatment. What does this mean? Obviously antivirals dramatically slow down the progression of HIV disease, but antivirals do not provide the immune system with any special protection against HIV when they are discontinued. They don't work like a magic charm. Is this an argument against early treatment? Absolutely not. If I take diabetics off their insulin, their disease returns. Is this an agreement for diabetic to not use insulin until diabetes has caused blindness, or the amputation of at least one limb? Well of course not. Only an insane person would make that argument. If a "diabetes expert" Bob suggested this, diabetics everywhere would be inclined to burn down Bob 's home. One of the tragedies of HIV disease is the inability of many to apply what we know from other diseases to HIV. They act as if HIV is a completely unknowable evil spirit like a bunch of cowering savages. This approach leads to death and destruction. There are some with HIV who have immune systems which maintain their T4 percentage above 30% and their T4 count above 500. These people will also typically have viral loads below 2,000 without antiviral treatment. For this population, which makes up less than 1% of the total number of people with HIV, non-treatment makes sense. But for everyone else with HIV, early treatment reduces both mortality (death) and morbidity (sickness from HIV). > > >Early treatment provides short-term benefits according to some research> >- http://www.aidsmeds.com/news/am20060919.html.> >So is the mantra "hit hard and hit early" back now ? Seems like they> >can't make up their mind about this.> > I think the data are fairly clear. Up to 24 weeks, it seems to give a bit > of a bang for the buck that washes out after 48 weeks.> > Suggesting that the idea of treating at or around seroconversion with > current ARV is probably NOT advisable. As a clinical plan or standard of > care, this would be simply risking more people developing side effects or > resistance earlier and possibly losing classes of drugs.> > By contrast, I think the evidence is growing that, if possible, ARV should > be started around 300 CD4. A lot depends on other factors like patient > willingness and commitment, rate of CD4 decline, CD4 percentage, viral > load, clinical condition, etc.> > Meantime, EVERYONE with HIV can start with or continue to use a > multivitamin. This has been shown to reduce progression and/or > morbidity/mortality among those with AIDS. A multi is not only safe, it > enhances health. And a multi early in disease may then further delay ARV debut.> > M. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 21, 2006 Report Share Posted September 21, 2006 The study you cite demonstrates that HIV antivirals are effective only if you take them. This is hardly as surprising or novel observation or conclusion. This would not have surprised you so much if you yourself had HIV and had experience with HIV antivirals. Insulin and virtually all other therapies are the same as HIV antivirals - they only work when you use them. This peculiar study compared HIV+ people who had not used antivirals to people who did use antivirals. After a year on antivirals the researchers had those who had been using antivirals discontinue them for half a year. Imagine their surprise when they discovered that after 24 weeks those who had previously been on antivirals still had lower viral loads when compared with those who never used antivirals. ly, that part surprises me too. But they were gratified when untreated HIV disease destroyed this immune advantage after more than a year off antiviral treatment. What does this mean? Obviously antivirals dramatically slow down the progression of HIV disease, but antivirals do not provide the immune system with any special protection against HIV when they are discontinued. They don't work like a magic charm. Is this an argument against early treatment? Absolutely not. If I take diabetics off their insulin, their disease returns. Is this an agreement for diabetic to not use insulin until diabetes has caused blindness, or the amputation of at least one limb? Well of course not. Only an insane person would make that argument. If a "diabetes expert" Bob suggested this, diabetics everywhere would be inclined to burn down Bob 's home. One of the tragedies of HIV disease is the inability of many to apply what we know from other diseases to HIV. They act as if HIV is a completely unknowable evil spirit like a bunch of cowering savages. This approach leads to death and destruction. There are some with HIV who have immune systems which maintain their T4 percentage above 30% and their T4 count above 500. These people will also typically have viral loads below 2,000 without antiviral treatment. For this population, which makes up less than 1% of the total number of people with HIV, non-treatment makes sense. But for everyone else with HIV, early treatment reduces both mortality (death) and morbidity (sickness from HIV). > > >Early treatment provides short-term benefits according to some research> >- http://www.aidsmeds.com/news/am20060919.html.> >So is the mantra "hit hard and hit early" back now ? Seems like they> >can't make up their mind about this.> > I think the data are fairly clear. Up to 24 weeks, it seems to give a bit > of a bang for the buck that washes out after 48 weeks.> > Suggesting that the idea of treating at or around seroconversion with > current ARV is probably NOT advisable. As a clinical plan or standard of > care, this would be simply risking more people developing side effects or > resistance earlier and possibly losing classes of drugs.> > By contrast, I think the evidence is growing that, if possible, ARV should > be started around 300 CD4. A lot depends on other factors like patient > willingness and commitment, rate of CD4 decline, CD4 percentage, viral > load, clinical condition, etc.> > Meantime, EVERYONE with HIV can start with or continue to use a > multivitamin. This has been shown to reduce progression and/or > morbidity/mortality among those with AIDS. A multi is not only safe, it > enhances health. And a multi early in disease may then further delay ARV debut.> > M. > Quote Link to comment Share on other sites More sharing options...
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