HIV/AIDS Awareness. A father’s choice.

Archive for the ‘treatment’ Category

We are working out way throught the 20 Things You Should Know About HIV (And Probably Don’t). Today let’s talk about one more important issue that may not be on everyone’s mind when thinking about HIV.

“Know your enemy and know yourself and you can fight a hundred battles without disaster.” ~ Sun Tzu

#11  The real enemy in HIV may be inflammation.

When your body gets invaded by viruses or bacteria or has to repair itself from injury, lots of fluid and cells run to the area. You may notice this effect from a swollen nose when you have a cold or the pain and swelling of a sprained ankle.

Something similar happens when you are HIV positive. When HIV chronically infects the body, cells and tissues are being destroyed and there is healing. But there is also inflammation that can lead to heart, liver and kidney disease.

Why is this important to you?

During the Asymptomatic Stage of HIV that lasts up to ten years (also called the latency period), this process of inflammation is still happening. When you hear that it is important to take good care of yourself and minimize getting sick from other infections, this is one of the reasons it is so important.

Whenever your immune system is activated due to illness or injury,  more T-cells are being made in your normal immune system response. HIV can then infect more T-cells and cause more damage in your body. You are in fact providing HIV with the environment to grow and the whole cycle starts all over again with each infection.

Your immune system is already turned on because of the chronic infection of HIV – even during the latency period. When you get another infection, it becomes highly activated and sometimes doesn’t turn off as well resulting in a prolonged inflammatory response.

The chronic inflammation that results causes tissue damage and scarring. It can also contribute to allergies, asthma or autoimmune diseases like arthritis. More importantly it can contribute to damage in your heart, liver and kidneys more commonly associated with aging.

There is concern that HIV leads to an overactive immune system which leads to the inflammatory response. While you might be thinking it is important to keep your immune system firing, it is now being shown that it is a good idea to calm the body’s over excited inflammatory response to HIV and potentially slow the aging process in people living with HIV. If not, you risk burning out your immune system even faster.

This speeds up HIV’s march on your whole body – not just your immune system.

How does this affect your path?

There is more research that is needed before we know how to prevent heart, liver, and kidney disease in people with HIV. But one thing needs no more research to be clear: HIV isn’t sitting around doing nothing during it’s latency period. It is leaving a significant impact on your immune system and your vital organs.

You choice to maintain good overall health by eating right, getting plenty of rest and exercising is even more critical than you may have thought. You do have some control over how HIV affects your body by the choices you make from the day you are infected.

 “Every man builds his world in his own image. He has the power to choose, but no power to escape the necessity of choice.” ~Ayn Rand

The power is yours. What path will you choose?

Now on to #10 of the 25 things you should know about HIV (and probably don’t). These 25 things will impact what you do and the choices you will make.

“A good retreat is better than a bad stand.” ~Irish saying

#10: HIV can retreat to places the immune system cannot follow like your brain.

HIV can cross the brain-blood barrier (move from your blood to your brain), infecting cells in your nervous system. Most immune cells cannot cross that barrier, which surrounds the brain and spinal cord, so HIV can retreat where the immune system can’t follow. It enters the brain soon after initial infection – typically within the first several days – but doesn’t cause significant damage right away.

HIV in the brain doesn’t go after your neurons, those important brain cells responsible for transmission of electrical impulses that control the body. Instead, it goes after other cells that have long lives. Once inside these long-lived cells, HIV can stay in a latent state for an extended period of time.

Rather than directly killing brain cells – as it does with CD4 T-cells elsewhere in your body – HIV affects your brain by setting off a cascade of damages through inflammation and oxidative stress caused by free radicals..

Why is this important to you?

The damage that HIV causes to your brain and to your central nervous system can impair your neurocognitive functions. That can bring on symptoms such as poor attention, memory lapses, and mood changes.

Understanding what your viral load is in your cerebrospinal fluid (CSF) as well as your blood plasma is something to consider this when working with your doctor on your treatment regimen. Some antiretroviral drugs are better than others in crossing the blood-brain barrier and they can impact your CSF viral load.

Reducing your viral load in the plasma and CSF may be necessary to reduce neurocognitive impairment, but it will not halt all the inflammatory responses or completely undo the damage caused by HIV’s march on the brain.

While effective antiretroviral treatment and recovery of your immune system dramatically reduce the occurrence of these complications in your brain and severe HIV-related dementia, mild-to-moderate impairment of your neurocognitive and motor functions is still a concern even with treatment.

How does this affect your path?

There seems to be a never ending flow of information that you have to know to keep up with HIV. Choosing to be a full partner in your treatment and understanding all you can about how HIV affects your body is going to be a huge decision for you.

 Battles have to be waged on many fronts to deal with HIV in your body. HIV is not just a disease of your immune system – it affects many of your major organs.

It will have to be your choice to stay on top of what is happening in your body and what is happening with your treatment. While it may seem that HIV has taken away some of your choices, it has presented you with a whole set of new ones.

 “Every man builds his world in his own image. He has the power to choose, but no power to escape the necessity of choice.” ~Ayn Rand

The power is yours. What path will you choose?

Yes, it’s #9 of the 25 things you should know about HIV (and probably don’t). These 25 things will impact what you do and the choices you will make.

“When you have a great and difficult task, something perhaps almost impossible, if you only work a little at a time, every day a little, suddenly the work will finish itself.”~Isak Dinesen

#9: It is better not to start HIV treatment if you can’t take your medicine every day.

Remember the old saying “In for a penny, in for a pound.” I used to wonder what that meant…  It means that when gambling or taking a chance, you might as well go the whole way and take all the risks, not just some.

In the case of HIV treatment, you’ve got to be in for a pound because you are taking more risks if you are just in for a penny.  If you don’t go the whole way and take your HIV meds every day as prescribed, you are far more likely to allow the HIV virus to mutate in your body and become resistant to the drugs that you are taking.

Resistance happens when the HAART therapy you are taking no longer works to keep your HIV viral load down. The virus starts to multiply and to damage your immune system.

Why is this important to you?

Your front line therapy against HIV is your best option to keep your viral load down and your CD4 count high. Drugs can stop working over time and you may need to determine what your second and third line therapies will be.

Losing one of these therapies because you can’t take your medication as it was prescribed lowers the options available to you to fight HIV. And you are going to want as many of them as you can if you experience side effects to some medications.

It is better to stop your therapy until you are ready to face it and take your medications every single day on time. Although there are risks that your viral load will increase if you stop, there is less risk that you will develop resistance to these life savings drugs.

How does this affect your path?

We have talked about the choices and decisions that you have to make when you are HIV positive in many of my blog posts.

This is going to be one of the biggest decisions you will ever make. It’s never too late to start and benefit from therapy, but starting earlier rather than waiting too long may decrease damage to your immune system and give you a better long-term health outcomes.

Starting earlier and not following your treatment guidelines not only causes you to lose the benefits of the therapy, it can cause you to lose a whole lot more.

Staying on any treatment program is difficult under the best of conditions. How many times have we all forgotten to take even a simple course of antibiotics for strep throat?

Taking medicines for HIV sometimes means taking a ten or more pills a day at specific times – some with food, some without. So it’s no big surprise that we might have some trouble keeping up with the schedule. You’ve got to take an honest look at your life and what you do each day that will support adhering to your program.

I know I have said it before, but you have to get in the game here and know all the rules if you are going to fight HIV.

Another one of those rules is that it does more harm to start your treatment and not follow it every day than it does to wait a little while until you are ready to commit.

 “It was character that got us out of bed, commitment that moved us into action, and discipline that enabled us to follow through.” ~Zig Ziglar

The power is yours. What path will you choose?

What a headline! For the first time in history, our waiting lists have exceeded 4000 people who are waiting to receive life saving HIV medications.

Here is latest ADAP Watch from NASTAD:

http://www.nastad.org/Docs/Public/InFocus/20101029_ADAP%20Watch%20update%20-%2010.29.10.pdf

Now I would like to switch gears here just a bit and share something that I read last week. Brown University has won a $7.5-million, five-year federal grant to study how drinking alcohol affects people with HIV.

The money, from the National Institutes of Health, will establish the Brown Alcohol Research Center on HIV which will conduct several studies on how alcohol affects health and behavior. Peter Monti (professor and director of the new research center) said both alcohol and HIV weaken the brain and the liver. Alcohol use can also make a patient less likely to follow his or her medication regimen or to abstain from unsafe sex.

In other words, we know that alcohol is not good for you if you are HIV positive. You might not take your HIV medication. This research will look at how much if any you can safely drink. We also know that if you don’t take HIV medication, the vast majority will progress to full blown AIDS and face disability and/or death.

My point here is not to discourage research. It is to say very clearly that we have to get our priorities straight. What good is it to have a National AIDS Strategy if we can’t even have a strategy to allocate federal funds to the highest priority issues. Issues of how to fund the shortfall in ADAP are being debated in Congress with nobody denying it needs to be funded but disputing how it should be funded.

I realize that the federal government allocates money from different pots and it seems none of those pots are even on the same stove…

Furthermore, it has taken the intervention of NASTAD – National Alliance of State & Territorial AIDS Directors to get cost containment agreements with major pharmaceutical companies like Gilead, Boehringer Ingelheim and ViiV for ADAP.

So it seems we are still waiting for a comprehensive and workable National HIV/AIDS Strategy from our leaders in Washington.

While we wait, 4,157 people are waiting to receive life-saving medication.

We are back with the 25 things you should know about HIV (and probably don’t) over 25 days. Today is #6.  These 25 things will impact what you do and the choices you will make.

“We don’t see things as they are, we see them as we are.  ~Anaïs Nin

#4: One of the biggest predictors of how well you will do living with HIV is a fighting spirit.            

Studies have shown that you will get sick less often if you have a good strategy to cope with HIV. When you are first diagnosed, it is an absolute shock and a life changing experience. Your life will never be the same and that can be stressful and overwhelming.

HIV is a life long condition that is often associated with severe stress on both your mind and your body. How you learn to deal with that stress (or have a strategy to cope with it) is going to play a big role in your life.

After you are diagnosed, you will need to work on living in this new reality. It is important to acknowledge that things have changed. The stressors that come with HIV impact the way you view your world, how you are able to deal with day-to-day situations, and the direction of your treatment. You may feel forced to confront illness, disability and death.

It is completely normal to feel fear, anger, guilt and maybe even denial.

Why is this important to you?

It is well known that a diagnosis of HIV can be very socially isolating. If you find yourself withdrawing from friends and family, feeling disconnected with your life, and perhaps being afraid of the stigma of HIV, it is more important that ever to make the effort to find a circle of support.

Long before the demands of HIV make a huge impact on your immune system, they are changing your emotional health. Only you will know when it is time to disclose your status to your family and your friends.

An HIV support group can be especially beneficial when you are trying to figure how to cope with HIV. To find an HIV support group near you, please use the AIDS Service Organization finder at http://asofinder.com.

How does this affect your path?

Are you going to fight or are you going to be defeated? This is a choice you will have to make that will impact the quality of your life and how often you get sick with HIV. It may also impact how well you do with HIV treatment.

If you have already made the choice to fight this disease and live your life without limitations, please make the choice to learn all that you can about HIV. A fighter knows the rules of the game.

HIV means facing life changes and losses. Your strength in coping with HIV means that there can also be wins.

“The world is round and the place which may seem like the end may also be only the beginning.  ~Ivy Baker

The power is yours. What path will you choose?

We are sharing 25 things you should know about HIV (and probably don’t) over 25 days. Today is #5.  These 25 things will impact what you do and the moves you will make.

“It is always your next move.” ~Napolean Hill

#5: HIV doesn’t just affect your immune system            

From the day you are infected with HIV, changes are happening in your body. We talk a lot about the changes in your immune system, but other things are happening as well.

Some of the changes are a result of the HIV infection and some are an unintended result of the treatment. Regardless of how they came about, issues that we might associate with aging like diabetes (high blood sugar), high cholesterol and triglycerides, and fat redistribution can affect those who are HIV positive.

Lipodystrophy, also called fat redistribution syndrome is the name of this group of symptoms. It is known for its changes in your body shape and in your metabolism.

Your body shape may change by the accumulation and/or loss of fat, which can affect your appearance. Metabolic changes may include increased resistance to insulin and those abnormally high levels of blood cholesterol and triglycerides. You may get one or more of these conditions if you are HIV positive.

Why is this important to you?

Doctors aren’t really sure why those who are HIV positive develop lipodystrophy, but they think it may be related to antiretroviral medications you take to control your HIV. It may also have something to do with your age, overall health, and how long you have been HIV positive.

But they are sure that you have a plenty of choices you can make each day that can improve the effects of lipodystrophy on your body.  A single choice that you make can often control more than one symptom.

These are long term conditions that have a progressive effect on your overall health.

How does this affect your path?

You are faced with choices every day and you can make healthy choices that can improve your symptoms of lipodystrophy. These include eating a healthy diet rich in fiber and “good fats” like Omega 3 and a daily dose of exercise that includes some use of resistance (weight training) and aerobic exercises.

Along with some treatments prescribed by your doctor, you have the power to make a real impact in this aspect of HIV and how it affects your life. If you have your viral load under control, you may as well look good while you are feeling good.

“He who controls others may be powerful, but he who has mastered himself is mightier still.”~ Lao Tzu

The power is yours. What path will you choose?

To read all of the 25 Things You Should Know About HIV (And Probably Don’t), please click on Kellys Blog to read each one of them as they are released. Or enter your name and email address in the boxes in the right column of this page. We will send you a complete copy of all 25 Things.

For more information on Lipodystrophy and other HIV related conditions, please check out our Info Center.

We are sharing 25 things you should know about HIV (and probably don’t) over 25 days. Today in Day #3.  We have identified these 25 things that you should know because they impact your actions and the path that you take..

“Nobody trips over mountains.  It is the small pebble that causes you to stumble.  Pass all the pebbles in your path and you will find you have crossed the mountain.”  ~Unknown

Day #3: HIV treatment is a lot more than just popping a couple of pills.

Today we are going to talk a bit more about the fact that people no longer think that HIV is a big deal. Even Oprah got caught last week saying, “You look at people like Magic Johnson and you realize that you can live a healthy, happy, long life” with HIV.  Sure you can Oprah, but there are a few facts that step in the way.

As Oprah’s guest Bridget pointed out to her… who wants to take pills twice a day for the rest of your life? Especially when the side effects of some of them can be wicked?

Those antiretroviral drugs that can make such a difference in living longer and getting sick less often (when you are HIV positive) are not something to be treated lightly. Doctors say that you have to remember to take your HIV medications as prescribed 95% of the time for them to be effective.

If you don’t, you risk that your HIV virus will mutate into something that is no longer responding to your medication. In short, your viral load will go up and your CD4 count will go down. More virus and less immune system.

Why is this important to you?

Getting treated for HIV means a lifetime of doctors, tests, and uncertainty. Even if you don’t feel sick.

When you are HIV positive, you will always be checking and rechecking on your health. During those first few years after you are infected, you probably won’t have any symptoms or require medication. But you will need to be checked every three months for a change in your health status.

I am not saying you can’t live a happy, healthy and long life with HIV. But do you want to live with that stress and uncertainty? Certainly this is a whole lot more than just popping a couple of pills.

When you do start to get sick from HIV, your viral load is up and your CD4 count is down. It will be time to start your antiretroviral drugs. Known as HARRT, this treatment regimen can be tough on your body with common side effects known as the big three: nausea, fatigue, and diarrhea.

You aren’t faced with a lot of choices here. Take the drugs 95% of the time so that they are effective (and save your life) but perhaps feel sick when take them.  Some meds must be taken several times a day at specific times and you may need to change what and when you eat, what you drink, and even what you do.

How does this affect your path?

Taking risks and exposing yourself to HIV is a choice that you make. Please remember that choice may be taking away a whole lot of other choices for the rest of your life.

“Some choices we live not only once but a thousand times over, remembering them for the rest of our lives.”~ Richard Bach

The power is yours. What path will you choose?

This morning I was reading the Huffington Post blog by Susan Smith Ellis, the CEO of (RED) – the HIV/AIDS organization founded by Bono and Bobby Shriver. (RED) is not a charity. It’s an economic initiative that has become its own brand, and it acts as an agency of sorts, forging partnerships with other brands (Apple, Converse, Motorola, Gap and Hallmark, just to name a few) that sell products/services directly to consumers.

Here is a link to the post: http://www.huffingtonpost.com/susan-smith-ellis/hivaids-medicine-is-only_b_674033.html

Susan makes a great point that HIV medicine is only one piece of the puzzle.  She notes that successful treatment for HIV/AIDS requires education, care, support, food and nutrition, as well as medication.  And she uses the example that with food and nutritional support, the antiretroviral drugs taken to treat HIV/AIDS are likely to be significantly more effective. And programs to provide treatment and care go hand in hand with prevention.

I couldn’t agree more.

Over the past several months, my team and I at MyHIVAIDSAwareness.com have been talking with others who are HIV positive and meeting with HIV community leaders. It has become increasingly clear that we have to know all the pieces of the HIV puzzle. It isn’t enough just to take your meds if you plan on living your life without limitations.

But knowing what those pieces are and fitting them into your life are significant challenges. There is just too much information to retain and too much involved with making it all happen in your life. This is leading to an incredible amount of frustration and unnecessary stress.

So my team has been hard at work focusing on the top ten challenges of living with HIV and doing something about making these pieces of the puzzle fit for you. The result of our work is a groundbreaking series of expert courses that are ten minutes long. That’s right, they are ten minutes – no more.

In the ten minute video course, we highlight key pieces of the puzzle for topics such as nutrition, exercise, and side effects. Then we turn the action over to you in a ten day action guide designed to help you fit what you have learned into your life. In my new online community, you will find support and guidance from others taking the course with you.

You become the expert at putting together your own puzzle. And you take control of your life with HIV.

Please make sure that you have signed up for our mailing list to get the first look at our Eating for HIV Expert Course and my new online community coming very soon.

And remember, there are no solutions without action.

There are times when fear is good.  It must keep its watchful place at the heart’s controls.  ~Aeschylus

Have you ever experienced a situation similar to the one described below?   

You are set for your monthly doctor visit. You have been feeling good, taking your meds, working out, and eating well. You stepped into the office and then backed out. The mere sight of it gave you the creeps. After a short while, you tried to step back in and couldn’t. You felt light-headed and your heartbeat started to go crazy. It sent chills up your spine. You felt the urge to run but you couldn’t — your difficult breathing left you immobilized.

What can we do about our fears? Can we stop them? Is there a way to use them to our advantage?

Fear is really designed to warn you. It is your body’s security alarm to keep you from stepping into unknown territory unprepared. If you re-discover the true role of fear in your life, you will find there are ‘good fears’ that lead to a ‘better safe than sorry’ approach or vigilance in dealing with your HIV status.

Fear is not meant to stop you, it could be used as a  means to warn you to be prepared. Fear tells you to think twice before you step out and do something you will regret later. It gives you time or another chance to think so that you can make better decisions and take fewer risks. This is the correct perspective on fear.

For instance, it is perfectly natural to fear getting an HIV test. It is not the test that is the real fear – it is the chance of the positive result. This fear can make you extra careful about the choices in your sex life.

We are also programmed to fear becoming ill or injured, especially the unknown factor in being able to take care of ourselves. This is not to stop us from living each day, but to keep us from doing things that could hurt us. This natural self-preservation is a huge motivating factor in choosing a healthy lifestyle and limiting the risky behaviors associated with HIV infection.

Here are just a few normal fears associated with HIV:

Fear of the unknown – If you don’t know much about HIV and what happens in your body, you might be afraid.

Fear of changes in your status – When your tests are good, you are doing great. But your viral load could go up on the next doctor visit and you worry.

Fear of disclosure – Could somebody at work find out? Will that make a difference with your boss? It is nature to be concerned about what others might think, say or do if they found out your status.

Fear of symptoms – You might get obsessed with each and every twitch or minor illness that you experience because of what it might mean  to your HIV. You spend a great deal of  itme taking your temperature, checking your lymph nodes and searching for signs of infection.

Anxiety starts with persistent worrying and causes a disturbance in your mood and emotional life. Mild to moderate anxiety is nothing unusual after a major life event like becoming HIV positive. But fears and anxiety can get out of control and take over your world if you don’t deal with them.

Want to know more about fear and how to use it to your advantage?

Please make sure you get on my mailing list by putting your email address in the box to the upper right or go to http://myhivaidsawareness.com.  I’ll have some more information about HIV fear and anxiety coming your way very soon!

We enjoy reading and watching Mark S. King’s chronicle of his life as a gay man in recovery living with HIV. It is a must read here.

Mark created a great video blog on Six Tips for Choosing Your HIV Doctor that everyone looking for or thinking of changing doctors should watch. I don’t think Mark will mind too much if I give you a preview on his most important tips:

1. Interviewing a doctor is common and okay.
2. Bring medical records and a summary.
3. Find out the doctors credentials and education.
4. Try to combine HIV and primary care.
5. Check hospital privileges.
6. Be sure you feel comfortable being honest.

Mark’s biggest advice is to not be afraid to ask questions about anything you think is important. It is absolutely okay to ask questions about a doctor’s background. If he/she doesn’t like your questions and gives you an attitude, get another doctor.

You can watch Mark’s video at:

http://marksking.com/my-fabulous-disease/video-16-six-tips-for-choosing-your-hiv-doctor/

National HIV Testing Day is June 27th

National HIV Testing Day

Every year since 1995, the folks the National Association of People with AIDS (NAPWA) organize National HIV Testing Day on June 27^th. They bring together local organizations around the country to work with communities in promoting early diagnosis and testing for HIV.

When you get to the facts that a quarter of the people who are HIV positive in the United States don’t know it, you can’t shake the absolute urgency of being tested. In last winter’s overblown anxiety about H1N1 flu, people weren’t flying or getting on trains because they feared infection. There were daily news stories about the shortage of vaccines and the steps you needed to talk to ward off infection.

But how often do we talk about HIV infection in the mainstream media today? Are you taking precautions to prevent infection?

Early diagnosis and access to treatment mean the difference between life and death for those with HIV. They can also mean the same difference for those you have sex or share needles with in the coming years. Knowing your HIV status helps you make better decisions for yourself and those you share your life with.

On June 27^th, state and local health departments, community-based organizations, HIV testing sites, and AIDS service providers across the United States will participate in events for National HIV Testing Day. These activities will include health fairs, community education, special events, and extended testing hours.

Right here in Phoenix, Southwest Center for HIV/ AIDS (www.swhiv.org) is offering free HIV testing on June 26 to honor National HIV Testing Day. Want to know more about events in your town or state?  Please go to http://www.hivtest.org/press_files/events.cfm and click on your state to see the events.

Knowledge is power. Know your status.

I started out to write a blog post about the true impacts of research news on the daily lives of those with HIV/AIDS. Part of what we do at http://myhivaidsawareness.com is to review each day what is happening the areas of prevention, treatment, care and research.

But then I came across an article posted in Business Week – http://bit.ly/c49GXl – and a few other publications that said, “Morphine May Protect Brains of People With HIV.” I looked a little further and found they studied this because doctors saw that HIV+ heroin users were not developing AIDS-related dementia. Okay, but doesn’t morphine have huge addictive and tolerance problems? Are we telling people to start using morphine or its close relative heroin?

To get past the headline, I looked a little deeper into HIV and heroin. Other research has found that drugs like morphine and heroin suppress the immune system and enhance the inflammatory effects of HIV on brain encephalitis. In other words, they can make you much worse.

You have to read past the headline and find that doctors are saying that a morphine-like substance could be developed that does not have the typical dependency and tolerance issues. They aren’t saying use heroin or morphine to protect your brain. But the headline sure sounded like an endorsement of morphine and no such morphine-like substance now exists.

Research is defined as the “systematic investigation to establish facts.” Individual research projects only look at a very tiny part of the whole HIV puzzle. Many times they present conflicting information that can be very confusing if you are trying to figure out a treatment regimen that works for you.

Most importantly, when we report on and/or hear about new research, we have to remember that impact of most research is years away. Just in the past few months we have heard about the potential importance of bananas, an acne drug, and some common anti-biotics in HIV treatment and prevention. But where does it fit in your treatment today?

We will continue to review and share the latest research findings especially those that hold promise for the future. But it is important to never forget that your treatment today is what impacts your future.

If you have questions about treatment, please check with your medical provider. If you wish to have some additional information about HIV treatment, I recommend some of these great resources that are available from Project Inform:

http://www.projectinform.org/info/decisions/decisions.pdf

http://www.projectinform.org/info/avs/avs.pdf

San Francisco public health doctors are urging patients to begin taking HIV medications soon after their diagnosis rather than waiting until their immune systems become compromised. Reports of this major policy change first surfaced last week in a New York Times article.

These new city guidelines – to be announced next week by the Department of Public Health – may be the most forceful in the world in their strong endorsement of early treatment against HIV. Doctors will offer patients combination therapy and advise them to pursue early treatment, but the patients will ultimately decide whether to begin therapy right after their diagnosis.

Antiretroviral therapy is traditionally used to stall or prevent the progression of HIV to AIDS, and it can also prevent other side effects of a degenerating immune system, like opportunistic infections and cancers. The downside is that ART can also cause liver and kidney damage among other complications.

The issue of when to begin treatment is an often discussed decision that we are asked to make with very little information on when to begin a lifetime regimen of costly and sometimes toxic medications. The answer to when remains in dispute, but San Francisco doctors are opting for treatment before permanent damage is done

Even our nation’s experts are solidly divided on the issue of when to begin treatment. In December of last year, only half of the HIV experts on the 38 member Department of Health and Human Services panel favored starting drugs in patients with healthy levels of more than 500 T-cells.

The issue for doctors and patients is whether the damage caused by HIV is more life threatening than the damage caused by some of the antiretroviral drugs. Doctors just don’t know the answer to that question right now. You can expect a great deal of discussion on that in the coming weeks and months.

We will be exploring treatment options in the next few days on our blog. Please check back for new insights on when to start treatment.