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Living
With HIV Decisions About Therapy
This was a
daylong course in April at the Chelsea & Westminster Hospital,
London designed for those living with HIV/AIDS. Professor Brian
Gazzard gave a welcome and introduction to the day.
He spoke of plans to improve services for positive people using
the hospital. Dr David Asboe, consultant physician, talked about
disease progression and its measurement. He focused on the progression
of HIV characterised by progressive loss in numbers and function
of CD4 cells and the opportunistic infections associated with
diminishing CD4 counts for example:
- 400
- Herpes
- 300
- Oral Candia & Tuberculosis (T B)
- 200
- Pneumocystis Carinii Pneumonia (PCP) and Kaposi’s Sarcoma
(KS)
- 100
– Toxoplasmosis, Cytomegalovirus (CMV) Cryptosporidiosis, etc
Dr Asboe went
on to discuss the clinical stages of HIV
- Primary
infection or seroconversion;
- Asymptomactic
stage;
- Symptomatic
stage and finally
- AIDS.
He talked
about factors that affected progression and why we measure it
before looking at viral load measurement. The aim of measurement
is to prevent disease progression.
Professor Brian Gazzard, Director of Clinical Research dealt with
the optimum time to begin therapy followed by Dr Graeme Moyle
who looked at treatment options. The final speaker before lunch
was Dr Anton Pozniak casting an eye on future antiretrovirals.
His best bet was that of taking your pills all the time and suggested
that future treatments need to be more user friendly. He outlined
some of the new drugs in trials like once a day protease inhibitors
and a new class of drugs that don’t get into cells (extra cellular)
like the fusion inhibitor T20.
Dr Pozniak
addressed the question of stopping treatment by pointing out that
the current evidence indicates that if you started treatment with
a low CD4 count, you will return to that point quickly when you
stop. It will also take a long time to get back up again. He believed
it was better to stay on treatment than stopping. He pointed out
that it isn’t the viral load that kills you, but not having a
strong enough immune system to prevent opportunistic infections.
Any rise in CD4 count helps you survive. The benefits of Interlukin
2 were mentioned.
After a sumptuous
lunch in the Atrium, Juliet Allom, Clinical Nurse Specialist,
talked about long and short term adherence, producing a graph
of statistics presented at the 1999 Chicago conference of the
relationship between adherence and virological control. She highlighted
the following ways that you patients can help themselves
- Prepare
well (Information and advice, consider risks/benefits and lifestyle
impact, take your time)
- Establish
a regular and ongoing support network.
- Use the
Multi-disciplinary team and voluntary sector Keep up to date
- Use practical
memory aids
- Be honest
with your doctor
- Try to
attend your regular, booked appointments
She mentioned
the following as potential barriers to adherence: Inadequate patient/professional
communication
- Unresolved
patient concerns such as fear of side effects – especially visible
ones or anxiousness about the social stigma of taking medicines
- Health
Care Professional related issues such as clinicians believing
that adherence is the patient’s problem
Dr Nick Theobald,
Associate Specialist spoke about involving your GP in you HIV
care and Bec Clarkson from the UK Coalition talked about their
‘Positive Futures’ project. Dr Mark Nelson dealt with the toxicity
of therapy options noting that the success of antiviral therapy
depended on the tolerability of drugs – a mixture of adherence,
toxicity and potency. He outlined the toxic effects associated
with specific drugs from AZT through to the latest nucleotide
Tenofovir
A lively question
and answer session ended the day in which the debate was led by
the voices of people living with HIV/AIDS. A set of fact sheets
from the Chelsea & Westminster Hospital can be found in the information/therapies
room at the Hanley Centre.
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