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Treatment Strategies
  

When to start treatment for a really older man

Posted: Aug 17, 2007

QUESTION:

Question: considering my age (75), I probably have only another 10-15 years of life max. US doctors increasingly seem to be in favor of early treatment. Would I benefit from starting treatment now?

Consider the following:

-I was diagnosed HIV positive in 2003, 4+ years ago

-My readings as of this week: CD4-236, 14% VL=9869

-I am in excellent health (other than HIV infection), have annual check ups, exercise heavily three times a week, walk a lot and watch my diet. No smoking, moderate alcohol. I am quite active physically and alert mentally.

-I am 75 years old

-I reside in Thailand. My doctor is considered one of the countrys leading HIV experts. He trained (residency) at San Francisco General Hospital and attends international HIV conferences. He seems to know his stuff. He does not recommend my going on treatment now, but has given me the option. His view is that US doctors are overly aggressive in recommending treatment at CD4 350; he follows the European model that treatment allegedly should start at CD4 200.

Thanks for your opinion. I am a regular, devoted reader of The Body newsletter. You guys are doing a great job.

JB

Here are results of CD$/VL tests.

Date/CD4/%/Vload 05/03 530 2,780 09/03 400 4,650 12/03 350 24% 2,130 04/04 500 2,040 10/04 220 19% 4,210 10/04 340 22% 3,440 05/06 250 17% 9,360 08/06 249 17% 5,000 06/06 265 15% 8,806 09/06 250 17% 5,024 01/07 179 14% 6,403 04/07 240 16% 34,868 08/07 236 14% 9,869


  

RESPONSE FROM:   

    JB, thank you for your post.

    Irrespective of age, with a CD4 count and percentage that is at the defining level for AIDS, I would be strongly recommending HIV medications. This isn't an emergency, but given that current medications are remarkably well tolerated, waiting to start medications is really more of an issue of delaying well-tolerated medications, only to increase your already significant risk of having an AIDS complication. Really a no-brainer, if this were my decision, or to put this into more personal terms, if you were my family member.

    It is highly reassuring that you're otherwise doing well and that you've got access to a very well trained doctor. Since I frequent both American and European discussions on this matter, I feel that I can speak for both communities, where the pendulum on both continents is very decidely moving back to earlier treatment, rather than later. I recommend to all of my patients with counts below 350 (and even for some, higher) that we start medications and monitor very closely for any evidence of side effects or intolerance. In the event of the later, it usually is a relatively simple mater of switching to an alternative regimen.

    Hope this helps, best of health to you. BY




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