Whether someone wants to treat when their CD4 count is above 500 or wait until it has dropped below 500 is the cornerstone of the current early treatment discussion. It is not that there is no evidence for starting treatment above 500; it’s just that it’s less strong than the evidence for treating between 500 and 350.
According to Dr Steve Deeks, who presented his views at the 2012 Australasian HIV/AIDS Conference, the bottom line is that there is ‘no harm’ in treating above 500 CD4 counts — useful assurance from a world expert on HIV.
And over a lifetime, what is the difference between taking treatment for 33 years versus taking it for just 30? What are a couple more years when there may be much to gain and so little to lose?
Plus, earlier treatment may well curb the seeding of the viral reservoirs, reduce HIV inflammation, preserve the immune system from further damage, help quell depression, reduce heart disease risk . . . as well as decrease the likelihood of passing on HIV to others.
The argument against initiating early treatment is often most vocal when it’s placed in the context of a way to lower infection rates. And rightly so. The primary reason to treat HIV is for an individual’s own health needs; although prevention may certainly be a secondary consideration, particularly for those with HIV-negative partners.
Dr Edwina Wright, of the Burnet Institute, expressed it eloquently when she said that no-one should be coerced onto treatment either for prevention or individual health, but they should be encouraged to consider treatment when their personal individualised health needs predict, first and foremost.
So, the final and ultimate decision, and choice, rests with you, the person living with HIV.
But before you make that decision, start by talking to your HIV-positive peers — they are the ones in the know. Be careful that you don’t only get the extreme stories (all roses or all problems). Look for balance by collecting a range of views.
Gather information on the particular treatment regimen that interests you or that your doctor has recommended. How important is one pill once-a-day? Multi-drug single tablets are not the be-all and end-all. There may be a combination of separate pills that will suit you far better.
Include your doctor as a partner in your planning process. Make an agreement about the thresholds you both think are reasonable. As well as CD4 count, these thresholds should take account of what else is going on in your life. Cost may be a consideration (something NAPWHA and its state and territory PLHIV member organisations are lobbying hard to address at the moment).
Contact your local AIDS council or PLHIV organisation and speak to a treatment officer or someone with a good grasp on the topic. Discuss the history and evolution of HIV treatment and where it is progressing; there could also be some good reasons to wait.
Never think that taking treatment is succumbing to the virus or admitting defeat. Regard it as getting on with the rest of your life. Popping pills takes ten seconds of your day. You then have 23 hours, 59 minutes, and 50 seconds to get on with the rest of it.
If and when you do start, take them religiously (95% of the time, at least), and keep up your routine checks with your doctor.
Don’t accept or put up with any problems if they arise. Treatments can always be changed if you’re not tolerating or coping with them.