This issue’s Specialist
Anthony Mills, M.D., AAHIVS
Dr. Mills is an HIV specialist in private practice in Los Angeles.
Newly diagnosed and starting therapy
I am 34 years old and from Brazil, and was diagnosed HIV-positive on March 6th of this year. Today I went to the doctor and for the first time got my CD4 count, viral load, and CD8 results. They are not good: my CD4 is 245, viral load was 188,000, and CD8 was 680. My doctor prescribed me zidovudine/lamivudine (Combivir) and efavirenz (Sustiva). My question is about her prescription since she’s not an Infectious Disease specialist but a pediatrician—trained by the Brazilian public health system to deal with HIV-positive patients. Nothing much can be done apart from asking for help. In April 2007, my blood tested negative for HIV. After taking the test in March of this year, I got the bad news about being HIV-positive. Should I start taking my HAART prescription or should I wait?
Also, what do you know about KP-1461 by Koronis Pharmaceuticals in the U.S.? Is this a real potential for a cure within the near future?
Bewildered in Brazil
Dear B in B,
I’m sorry to hear about your recent HIV diagnosis, which I know is never easy. I tell my patients the important thing to remember is that having HIV does not necessarily mean that your life will be any shorter, or any more difficult. We have made amazing advances in the treatment of HIV in the past few years, and I believe all HIV patients can live very long and full lives. What it does mean is that you will need to see your doctor regularly, have your blood tested regularly, and possibly take medication at some point to help your body fight the HIV. It sounds like you have a good doctor taking care of you and her recommendations seem appropriate. Here in the U.S. we have two organizations that issue guidelines that suggest to health care providers when to start antiviral therapy. Both organizations currently recommend that patients with fewer than 350 T-cells initiate therapy regardless of how long they have been infected. Every person is different in how his or her individual body responds to HIV and how well they are able to fight the virus without medications. Some people are able to go for many years without needing meds, but most need the help of HIV medications eventually. The timing of the start of therapy is most often based on the T-cell level. The regimen she has selected for you is one that we have much experience with and has been proven to be an excellent regimen in many clinical trials, as well as in our daily practice. So my answer to your first question is yes, I would agree with your doctor that you should start medications to treat your HIV, and I agree with her recommended therapy.
Your second question about the new Koronis investigational drug is a more difficult one to answer. The Koronis drug theoretically works by causing the virus to mutate or change itself at a very high rate, and the hope is that it will change into a form that would be harmless to the human body. The concept is very exciting and we are all anxious to see the results, but the trials are in very early stages and nothing can be said about its effectiveness at this point, or about its safety. [Editor's note: As Positively Aware went to press, development of KP-1461 was suspended after an analysis of current data failed to show activity against HIV. ] (For more information see “KP-1461” in the September/October 2007 issue of PA.)
Anthony Mills, MD, AAHIVS
Los Angeles, CA
Dr. Mills is an HIV specialist in private practice in Los Angeles. Visit www.tonymillsmd.com.
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