Can you live forever with HIV these days?

Factual Questions
1

On television the other day I heard someone say “HIV isn’t a death sentence anymore”.

I am great that the advancement of science has allowed us to control this virus.

But if I started to show the symptoms of HIV - I don’t know what I would do, nor any virus, for that matter. I do not have health insurance, my employer does not provide health insurance although I work many, many hours for his company, and after much investigation, I have found that any health insurance cannot reasonably fit within my very detailed budget.

I am sure that in order to live happily ever after with HIV one must ingest quite an expensive drug cocktail. How is this done when you don’t have health insurance?

And the government appears to be helping people like me who do not carry health insurance, but at a cost of much higher taxes, and it does not seem that they are controlling the cost handed down to us by pharmaceutical companies, medical associations, hospitals, and doctors. Am I wrong?

2

I heard a gay acquaintance say once that “Having HIV nowadays is like having a hairdo.” (In other words, something that you have to consistently maintain, but ultimately is more of an annoyance than a life-ruining terminal illness.) I have no idea if this is a common view among gays today, and I thought it an exceptionally cavalier thing of him to say, though I really didn’t feel comfortable pushing him any further on it. This guy was the spoiled son of a rich family and I’m sure that if he ever needed an expensive cocktail of drugs every day, the expenses would be trivial for them. Someone poor and uninsured - not so much.

3

I just started on antivirals last night - Viread (tenofovir) for the treatment of Chronic Hepatitis B. The drugs have only just been approved by NICE (the rationing body for the NHS in the UK), so I pay nothing (not even the usual £7 co-pay per script), but a quick Google indicates that they should cost about £320 per month ($530USD). I could not pay that at all, and given that I will probably be taking antivirals for the rest of my life, access to fully subsidised treatment programs will be a major factor in where I choose to live (UK, NZ, maybe Australia). I do pay for personal health insurance, to ensure that I can get treated for some conditions by the specialist of my choice at the time of my choosing - important for me as a contractor with no sick pay. This does not cover my HepB, though.

Viread would only form part of a cocktail for the treatment of HIV infection, costs are obviously higher, but other combinations excluding the latest most effective drugs are cheaper.

As for how you get treatment in the US without insurance cover - I don’t know. People may have to wait for treatment on the NHS, and may not get access to really expensive “heroic measures” with small benefits, but everyone does get fully treated for free, even the unemployed.

Si

4

The antiretrovirals make it possible for people with HIV to live long enough to be killed off by other things. So if you’re 30 and get HIV, you can live then more years till you get into your heart attack years and die from one of those instead.

Since retrovirals came into popular usage in about 1997 they have only so far been able to increase life spans for at least 12 years, but who knows.

The thing is I have known HIV patients who pop a pill a day and are fine. And I’ve also known HIV+ people that have horrible reactions to them. From the “AIDS hump,” to vomiting, weight loss, and mental imparment. One guy I know said the pills were worse than when he got sick from HIV.

But like I said there are lots of people that take them with minimual or no side effects. There is not one antiretroviral but lots of them. The patients generally take three or four types of them at a time. The HIV virus can adapt to one or even two type of antiretrovirals, but at least three seems to be the point where the HIV virus is kept at bay. (These three or four types can be combined into a single dose for some)

Does everyone who is HIV+ need the antiretrovirals? That is a HUGE issue.

The current thinking is yes, but there is still lots of legit (and not so legit) opposition, saying you should wait to take them.

HIV+ people are not classed as disabled so are not eligible for medicaid or other types of welfare. Once they are diagnosed with AIDS they become eligible.

The good news is, gay organizations are very good at helping people get meds. I have not known one person who needed the meds, that some private organization will help them get it.

The drug companies themselves offer reduced rate (note: most drug companies offer this service for all types of drugs from Asthma, blood pressure, insulin, etc). They will offer you very cheap meds for long term conditons. Look on the pharmaceutical websites for assistance and apply. It’s not a quick process so do it ASAP.

In defence of the pharmaceutical industry and HIV, when I last checked the US government developed 6 of the antiretrovirals and other nations developed 2. The rest of them have all been private pharmaceutical companies and there are around 50 types of antiretrovirals when I last looked.

So as much as we complain about cost, I always remind people how many gay men, and other people around the world are alive today because of the “big pharma” and what it would have been like to rely just on governments. Can you see GW Bush pushing to develop a new “AIDS drug”?

The treatment for HIV is so unique to each patient. HIV mutates so often that not everyojne with HIV has the same type. Some forms are very troublesome others, no so (well in comparison).

So just Google around HIV treatment and you can see the tons of pages from people with HIV and doctors and researchers all giving their opinon.

Look at the fuss we had with a simple mammogram last week, and HIV is much more complicated than that.

5

Australia and NZ provide subsided treatment for their own citizens but you’ll find it almost impossible to immigrate here if you have any kind of disease that requires permanent anti-viral treatment. A full medical including blood samples and tests for HIV and Hepatitis is part of the immigration process.

Just went through this getting my UK partner a visa as my de facto.

6

I’m a kiwi with right of abode in the UK - so no issues.

Si

7

Yes, the newer strains confer immortality.

8

No, this is not a common view among gays, though we’ve all heard it. It tends to come from young people who think they’ll live forever. Unfortunately, these guys weren’t around in the 80s, to see the horrible nightmare our friends and lovers had to endure, when there was no treatment at all . . . and we could do nothing but hold their hands while they died horrible deaths.

9

I heard on NPR that there were some odd neurological effects cropping up in long term HIV treatment. I don’t think if they know it is the drug, or the virus.

10

>I always remind people how many gay men, and other people around the world are alive today because of the “big pharma” and what it would have been like to rely just on governments. Can you see GW Bush pushing to develop a new “AIDS drug”?
The government run health iprograms s buy drugs from private pharmaceutical companies. If the US went with a system like the NHS it would still be a similar situation. You dont need the president to sign a bill authorizing research. Heck, even the NSF and other publically funded organizations were giving grants to things GWB didnt like during his reign.

11

:smiley:

12

Markxxx covered this well but I’ll add my 2 cents too.

I worked on an AIDS-related study for a number of years, ending only recently, so I saw a wide range of cases. I saw people who looked really healthy, including one guy who showed me the picture of him at 90 lbs in multiple organ failure, but who at that point was muscular and looked great. I saw people who had that fairly common gauntness to their faces and took a number of meds, but aside from a few side effects were OK. One guy whose kidneys failed due to the medication regimen, and he eventually did die. One who lived quite a while with Kaposi’s sarcoma, and wore foundation to camouflage the facial discoloration caused by it, until he died. One guy had a family history of heart problems, died in his 50s of a heart attack. One is coming in today for a visit; he’s in his 70s and is doing pretty well all things considered. One had an opportunistic infection rob him of a lot of his eyesight; his retinas are damaged and he will never recover that. He’s worried about his ability to continue in his line of work. One guy looks good but they had problems getting his CD-4 count up; he had a hip replaced due to avascular necrosis related to HIV infection, but they had to wait many months to replace the other since his immune system was too poor. Meanwhile he was on a lot of pain meds for the hip.

Too many deaths, though. Not as many as back in the bad old days before lots of options for HIV antiretroviral drugs and intense combination therapy (HAART/highly active antiretroviral therapy), but still too many.

I’ve seen everything from one pill a day and no real side effects to frequently-changing combinations of pills and shots with side effects like diabetes, kidney problems, sky-high cholesterol, diarrhea, and pills for those side effects, plus prophylactic antibiotic use every day to ward off other infections.

In the US, either you have a good insurance plan, or you desperately struggle to get onto Medicaid or some other plan, if you want those drugs covered. They’re expensive.

13

Not sure about the higher taxes bit, but I do know that if you have NO insurance at all, and no medicare and not eligible for those, you’re actually better off at receiving Antiviral treatments than those caught in the middle thanks to programs like the Ryan White HIV/AIDS Program which offers grants and access to HIV Care for those in the most dire of circumstances. I believe in my area, the doctor said it was something like if you have no insurance and made under $30k a year, this grant would allow you to basically cover your treatment for you, with you not having to even pay a dollar in co-pay. It sounded pretty amazing, but it’s an interesting program out there.

As for your initial question of living forever, well that Data is out on that.
The major therapy programs current in use seem to be the HAARTregiment, which was implemented around 1995-1996, so the data isn’t really sufficient there for those with HIV and strictly adhering to the medication routines. But it does seem to be helping at least at reducing viral loads. The trick is that HAART does not “cure” HIV, it merely reduces the SPREAD of the viruses, so while it cannot cure cells, it can try to cut down on the number of HIV infected cells, or the production of more HIV cells. So while you can’t really “recover” from HIV, you can at least try to hope to manage the HIV and delay the progression of the disease, and especially in trying to stave off the AIDS condition itself.

So it’s not quite a cure, but it can help some people live much more longer lives than before, and again- the data just isn’t there to see how much of a benefit it can provide, but all signs seem to indicate that it’s certainly better than nothing.

Also, there are plenty of side effects from the various types of medications- neurological issues such as personality changes, and mood changes can be a side effect of some medications (the more likely cause of neurological symptoms than the actual disease itself), if you are experiencing those signs, you should try to talk to your doctor about it and see if there are any alternatives or such that you can pursue to try to help alleviate those symptoms.

14

So is the difference between being HIV poz and full blown AIDS, the number of cells that are infected with HIV?

15

Generic HIV medications produced in an Indian pharmacy cost $800-1000 a year for 3 drug therapy.

http://www.africaaction.org/docs01/drug0101.htm

Brazil and Thailand are also either doing this or considering doing it (breaking patents to manufacture generic HIV medications domestically and dealing with the legal consequences later).

16

I believe the distinction is based primarily on white cell count - when that reaches a certain level, you become extraordinarily vulnerable to opportunistic infection, and are considered to have AIDS.

17

Thing is, HAART can require pretty tight dosing–a 2-hour delay can increase your likelihood of viral load increase significantly. A reasonable number of people have significant side effects from the medications, ranging from severe diarrhea to strokes. That’s for the lucky people who are able to get treatment. I can’t speak for the strains around now, but in the 1980’s, my friends without medication died in under 2 years after diagnosis.

18

:nod: Medicine and AIDS treatment has come a long way since the 80’s. HAART itself was really only started in 1995 or so. The problem with the early forms was we were using monotheraputic means to try to combat HIV. The problem was that the HIV virus itself is HIGHLY prone to mutations. The problem with putting someone on only one type of therapy (AZT i think was the big “miracle drug” of the late 80s) was that just giving it time, eventually the virus inside of a person would become resistant to it. So basically you were enforcing selection, the virus would be killed off except for the mutants that were resistant to the drug. Then that strain would take over the person and infect them.
And then we’d create a new wonderdrug and start them on that one, and again it’d work really well until once again the mutant virus mutated again to create another resistant strain. And then after a while, it’d would colonize the person and now you’ve got something thats resistant to both types of drugs out there, and you’re in trouble.

HAART sorta came along and changed that- with the goals of agressive therapy, and using a “drug cocktail”- you basically start a person on not one, but two different types of RT inhibitors to take out the virus, and you also then add in a Protease Inhibitor as well. So you’re attacking two different stages of replication in the HIV molecule AND you’ve got two different mechanistic drugs going about it for one of those attacks.
The goal here is to quickly drop levels of HIV down and by using a multi-drug approach you’re hoping that the virus can’t just spontaneously mutate 3 different ways of resistance. It might become resistant to one of the RTs but then the protease inhibitor will stop it; or that it becomes resistant to the protease inhibitor and then the RT inhibitors stop it.

That wasn’t really how we were doing things in the 80s where it was pretty much touch and go- with people being put on one medication until it failed, and then being put on the next one- so basically you were creating strains that were just growing in resistances.

It’s really quite amazing, and hopefully there will still be advancements and improvements. Just in the last few years they’ve discovered a NEWER novel approach to attacking the virus from ANOTHER different point in replication via the means of an integrate inhibitor. So now there’s development of drug cocktailss which can combine all THREE methods to combat the virus and the goal is to have an individual basically not shedding or spreading more virsuses- so that his viral loads are are undetectable levels.

And yeah to address the other question:
HIV is a positive Western Blot test proving that a person has the viral infection at a detectable level- AIDS is the Autoimmune DEFICIENT state when a person’s White Blood Levels (CD4 specifically tend to be used) are below a certain amount thus making them prone to very rare and opportunistic infections. AIDS can be diagnosed simply by the presence of having one of those rare disease and cancer states, because normally a person would never have that disease unless their WBC levels fell below a certain point.

AIDS is a pretty fatal condition, and that’s the problematic one with the worse outcome. The goals are to try to treat people in the HIV stages to reduce their infection and basically try to stave off the AIDS stage from happening. The longer we can prolong people from the AIDS state, the longer better lives they’ll be able to live. AIDS is one of those things where “people don’t really die from AIDS” ie: having no WBC’s and such, but they die from very simple diseases and rare diseases that can easily ravage their weakened bodies. So you have people who die of things like PJP, PML, and MAC, weird lil’ diseases that basically are opportunists that can be fatal to those with weakened immune systems and are often used as a warning sign that someone has not just HIV, but either a very severe case or basically AIDS.

20

FTR doesn’t appear to be a spammer in spite of link, and new join date.

21

Yes, I can.

Regards,
Shodan