Q&A – Ask Our Health Mentor

Q. Can HIV kill when you have an undetectable viral load? I’m doing well on medication and how long can i live to the cure? Lastly, why can't I stop thinking about my HIV status – first thing in the morning and also just before I fall asleep? Polio have been eradicated but why can't scientists do the same for HIV?

A. The quick answer is that with modern HIV drugs (called ART) your life expectancy is likely to be similar to if you were HIV negative. The earlier someone is diagnosed and start ART, the quicker any damage from HIV can be reversed.

For most people, HIV is easy to treat and easy to manage. ART can give you a normal life expectancy and an excellent quality of life. How long anyone will live depends on things you can change (smoking, exercise, medication) and thing you can’t (genetics and luck). A study in Denmark (2005) estimated that the survival is more than 35 years for a young person diagnosed with HIV infection and another study in Canada (2003) report that in the US, life expectancy at age 20 years was an additional 58.3 years.

As long as your CD4 count stays above 200 cells/mm3, the risk of most HIV complications is pretty low. At higher CD4 levels – above 350, or 500, or 700 – the risk becomes lower still. Although some health problems are slightly higher in HIV positive people compared to HIV negative people, these risks are also often reduced by ART.
If you continue to take your medication as prescribed and do not miss or taking doses late, then the risk of HIV health problems in the future is very low. However, just as HIV negative people become ill, lifestyle changes to reduce these risks are important if you are HIV positive. For example, keeping mentally and physically active, eating a balanced diet, resting well, not smoking etc).
Having HIV might not always be easy though. The shock of being diagnosed sometimes takes a long time to come to terms with and at the moment you are still working on this. Already, I am sure you feel better than when you were first diagnosed and this will continue to become easier every year.

Most people worry about the impact of HIV on their life. This could be why you think about your HIV status on a daily basis. If this continues to be difficult perhaps get in touch with a local support group or ask about counselling. Talking about your HIV status can help you to deal with it and also through group support you can share experiences and also learn from one another. You do not have to deal with it in isolation.

Finally, you asked about research into a cure. HIV is very complex in a way that is different to polio. Although currently there is no vaccine or cure, there is a lot of ongoing research.
HIV treatment is one of the successes of modern medicine. The breadth and expertise in scientific advances has not only developed 30 medications in five drug classes but this research has contributed to many other areas of medicine.

Even though curing HIV is difficult, there are lots of reasons to be optimistic.

Q: Should I be so optimistic now I have started treatment?

I am a healthy male, 40 yrs old, HIV-positive for 18 months now.

I’ve been on meds for 8 months, yes, started sooner than expected. My viral load was 400,000 and my CD4 was 180 when I started meds, and it is now undetectable with CD4 count of 490 cells/mm3.

I am on Atripla (efavirenz+tenofovir+FTC) and would like to ask if it is wrong to feel so optimistic about my future? I only experience side effects if I eat a sugary meal too late at night. Dreams become a bit dizzy, so I avoid this kind of food after 9pm.

Should I take my meds every night or can I miss an odd one? Can this regimine last for many years?

I feel mentally HIV-negative again, though would never have unprotected sex again. I don’t want anyone giving me anything else! To people who are afraid of the meds I would say “don’t be” – as I said mentally more than anything they have saved my life.

A: Yes. You should be so optimistic, as apparently the therapy works perfectly OK for you. This means that if you take it appropriately, without missing doses, then it is expected to work for you for many years to come. That really is great news.

If you find adherence difficult and miss doses this may lead to resistance and you would have to change your therapy. You should tell your clinic about this and they may be able to help with other ways of support. A new combination may be less agreeable with you, so, perhaps it does not worth blowing your chances – take adherence seriously!

The advice about food relates to a high fat meal, rather than one that is high in sugar (though some food is high in both). A high fat meal increases drug levels of efavirenz, which will make those side effects (dizzyness, dreaming) more likely.
Otherwise, yes, make your plans and live your life. Great news!

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