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Why should we treat HIV?

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Last week we looked at the theoretical aspects of the treatment of HIV. This week, we look at the practical benefits. Why should we treat HIV? The question can be answered by saying “look at Magic Johnson”. This is someone who got the “best” treatment and over 25 years later is doing fairly well. The “best’ treatment is called HAART or “highly active antiretroviral treatment”.{{more}} It usually consists of at least 2 different medications from the class called the reverse transcriptase inhibitors and a protease inhibitor, a total of at least 3 different tablets daily. Sometimes, based on your response, the type of virus (1 or 2) and the viral load versus your CD4 counts, 4 or 5 different medications may be needed. This means increased costs and side effects with resulting decreased compliance. In order to avoid this, newer medications are always being researched and developed. We still have not found an effective vaccine to date, that is despite the rumours. Herbal remedies are hailed, but have proven ineffective and only one anecdotal but successful bone marrow transplant is documented. The problem is bone marrow transplant is fraught with its own dangers and like all transplants, it is expensive and one has to find a “match”. So what are the benefits of treatment?

1. Reduced mortality, especially if treatment is started early, compared to late. Early treatment means treatment before the CD4 counts falls below 350.

2. Earlier treatment in children also leads to reduced mortality, as the disease tends to be more aggressive in children.

3. Improved quality of life especially in patients with HIV1 infections and a high viral load that usually have a high mortality.

4. Increased survival: on average, patients who take medication live for more than 20 years, while those who do not, live an average of 9-11 years.

5. Reduced transmission from mother to child if the medications are taken when the infected mother is pregnant and breastfeeding. Infected mothers have a 25 per cent risk of passing the infection on to their unborn child without treatment. This risk reduces to less than 1 per cent with medication. Caesarian sections and a strict no breastfeeding policy after delivery reduces this even further.

6. Reduced infections from infected needles. If you are stuck with an infected needle, immediate treatment with an antiretroviral continued for a month significantly reduces the risk of contracting the infection. This prevention regimen is called post exposure prophylaxis or PEP.

7. Reduced complications. Patients who are compliant with their medications are less likely to suffer complications of their disease.

8. Reduced sexual transmission. Infected patients should use condoms when engaging in sexual activity, but if they do not, they are less likely to transmit it to their partners if they are on medications compared to if they are not.

We have dealt with medical treatment, but the use of condoms by itself can reduce and possible eradicate new infections completely. Circumcisions can also reduce this risk, but only after the first 6 months after circumcision of a sexually active male, unless it is done as a neonate.

For comments or question contact:

Dr. Rohan Deshong

Tel: (784) 456-2785

email: deshong@vincysurf.com

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