First the good news…

The Dutch have figured out that a person who is diagnosed at 25 will live an average of another 52.2 years – meaning they live into their upper 70s and have a pretty normal lifespan. So as we’ve sorta known for a while now – HIV is genuinely going from a “killer” to an “inconvenience” and that tren will probably continue as years go on. I don’t mean to diminish how big of a hassle being poz can be, but if you get diagnosed quickly and generally take care of yourself, it would appear you no longer need to worry about your life being cut short because of HIV/AIDS. But getting diagnosed fairly quickly is essential…

[That should be very good news for the 18 y.o. Teen Cumhole I talked about in my last post...]

Now for the bad news…

The bad news is that they’re not so optimistic in Africa. The South Africans are suggesting that everyone who becomes poz be put on meds immediately whether they need the meds or not. When you think that a lot of the people who are dying of AIDS today are people who are having serious complications from the meds they took 10 and 20 years ago, that’s a dangerous policy. I’m all for people taking the meds they need, but I’m a fierce opponent of medicating people who don’t need it.

The issue here is really one of which comes first – the rights of the individual or protecting the wider community from the danger posed by the individual? Americans will usually say the individual comes first, but in Europe and elsewhere the community comes first. But I think it’s important to remember the good news from the first part of this blog post – IF you get diagnosed early and are financially able to get treatment there really is very little risk to the community. But in poor countries like South Africa they don’t have the money for great treatment and so they have debates like this. I just hope no one in the first world tries to make an argument for mandatory medication… That would just be horribly wrong.

There seems to be an upswing in Hep C cases in poz guys in NYC…

Researchers in New York City are reporting their work uncovering a new epidemic of hepatitis C virus (HCV) infection among men-who-have-sex-with-men (MSM) who have HIV infection. These authors have previously reported unusually rapid fibrosis progression due to new HCV in MSM who have HIV infection and now expand on their findings, demonstrating that sexual transmission rather than injection drug use is the route of infection. Treatment is highly successful if started early in the course of infection, however, they report ominous news about liver disease progression. “This epidemic represents a new clinical syndrome for HCV infection that turns much of our knowledge on its ear: a new risk group becoming infected through a previously rare route of transmission resulting in unprecedented progression of liver fibrosis,” (Source)

Previously Hep C was almost always transmitted through shared needles. Now they’re seeing a fair amount of Hep C passed through sexual contact. So detection and early treatment are important. What I don’t understand is why they’re not worried about sexual transmission among neg guys.

So when you go in for your routine tests, make sure you get tested for Hep C – it’s not just for drug addicts anymore. I’ve always heard Hep C can be worse than HIV – so don’t take this lightly.

UPDATE: Another piece of research has been released that says that fisting is one of the primary risk factors for Hep C in men who are already poz. Basically it’s blood, not semen, that’s doing the damage.

I’ve always held the view that HIV was becoming less deadly because deadly forms of viruses kill off their hosts more quickly and have less chance to replicate. But a study that’s just out refutes that and shows that in a controlled population (the military) they’re seeing HIV become more virulent as measured by how quickly after infection the person’s CD4 cells drop and they need to go on meds. [Additional discussion of the article is available elsewhere.]

Researchers studied data from more than 2,000 HIV-positive active-duty military personnel, retirees, and dependents between 1985 and 2007 who had tested HIV-negative within the previous four years. When they looked at patients’ first CD4 count after HIV diagnosis, they found that it decreased from an average of 632 cells/mm³ in 1985-1990 to 514 cells/mm³ in 2002-2007. Additionally, 25 percent of patients diagnosed with HIV in recent years already had fewer than 350 CD4 cells/mm3, the threshold for when antiretroviral therapy should begin, compared to only 12 percent of patients in the late 1980s.

The authors note that the trend seems to have stabilized, perhaps due to the widespread introduction of highly active combination antiretroviral therapy.

It suddenly struck me what the flaw was in my theory… Medications… Basically meds change everything and let people with virulent forms of HIV survive longer – as long as people with mild forms of HIV. But that’s not quite right either since when someone is “undetectable” they pretty much can’t pass on the virus. But perhaps the more virulent strains are exceptions to that rule? Or maybe we’re really talking about a small population of “gift givers” and the gift givers with the most aggressive strains are are more likely to have their “gifts” be “successful”…

The point is ARVs most likely changed the rules in this scenario and HIV may indeed becoming more virulent, not less.

The reporters at The Onion discuss the unrealistic views of sex that are promulgated by a sex-positive porn industry and how they affect kids’ views on sex…

A new study in The New England Journal of Medicine says starting HIV meds early reduces your chance of death. People who started their meds when their CD4+ count was in the range 351 to 500 had a death rate of 1.6 deaths per 100 person years while people who started their meds when their CD4+ count was over 500 had a death rate of 1.3 deaths per 100 person years. Since it’s from the New England Journal of Medicine I’ll assume all of their assumptions are reasonable and the research methodology is as good as it gets.

When you read some of the articles that discuss the findings of the study it’s really a balance between drug toxicity over decades and staying alive.

“It must still be recognized that the long-term side effects of the anti-HIV drugs we now use are unknown, and could alter this recommendation after longer patient follow-up,” said Dr. Jeffrey Laurence, a professor of medicine at Weill Cornell Medical College in New York City.

That I think is the one possible weakness in the study – they studied people between 1996 and 2005 – so basically a decade’s worth of data. If a kid goes on the drugs at the age of 20 he’s got 60 years of taking drugs if he wants to live to 80. The study states:

Starting therapy at progressively higher CD4+ counts has been shown to lower the risk of some toxic effects associated with antiretroviral therapy, including peripheral neuropathy, anemia, and renal insufficiency. However, all the potential side effects of long-term antiretroviral therapy are unknown.

In other words, no one can tell you they know what the side effects of the drugs will be after taking them for 60 years…

While this study does give some strong evidence, it (combined with the other studies already done) leave some questions unanswered. In the end it’s a personal decision and everyone should do the research and make their own decisions… It’s your body and your life – you’re the only one that’s responsible for it.

In the news is that an Australian researcher has come out and discussed the fact that HIV is becoming less deadly and eventually most likely won’t even be lethal or debilitating. This is something I’ve been saying on here for a while now – HIV, on average, is a lot less lethal than it used to be and the trend will continue. It’s a pretty simple fact that a virus that kills its host quickly will not spread as well as a virus that takes a long time to kill its host (or one doesn’t kill the host at all). The researcher is taking a very long term view with that trend and saying that eventually (if humans survive that long) the virus will be so weak or we’ll have adapted to the virus that it won’t bother us at all…