Thank you for the opportunity to write a few words in the column for Positive Lives. I hope you find it informative and interesting.

This month I would like to focus on the many dilemmas that come, when deciding when is the right time to start treatment, and which is the best combination for you. In this rapidly changing world of HIV treatment there are arguments for and against starting antiviral treatment as the spectrum of anti HIV drugs continues to expand. We all need to understand how they work, potential side effects, problems with resistance and future developments.

The best time to start treatment is still subject to debate, The British HIV Association recommends that you should be offered treatment when the CD4 count is below 350, or falling rapidly, or viral load is above 1O,OOO copies. Research has shown that if you slow down HIV it will slow down disease progression and that the less HIV damages the immune system the better, as some immune damage may be irreversible.

Starting treatment can however mean major lifestyle changes, and the possibility of side effects. If you feel that you may not be able to persevere with them you may be better to delay treatment. Also if you start treatment you may be less able to benefit from future developments in treatment due to resistance. It is therefore essential that you are given information and space to explore their relevance to you in a manner, which is non-threatening, and patient centred rather than authoritarian. As a Nurse Specialist I can offer information, time and guidance but always with the emphasis on you having control and the right to determine you own life.

Just a quick note concerning resistance testing, as you may know there is no point in doing resistance testing a long time after you have finished the anti viral drugs, because the virus quickly reverts back to wild type virus, meaning any resistant virus become difficult to identify. Just to reassure you that all bloods sent to Birmingham for viral load testing are kept! So you can do a retrospective look back and identify any resistant strains you may have had while you were on the drug. If you have any queries about this please phone me on 552350 or grab me at the centre

Cheers

Peter Butler
Clinical Nurse Specialist