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This approach waits for active infections and disease to occur. In HIV, this means watching out for such things as thrush, pneumocystis, KS lesions, and so on.
Advantages
It is easier to believe and take action when we are faced with an obvious illness. People who feel sick usually want to treat the illness as soon as possible.
Disadvantages
HIV may progress before symptoms appear. By the time symptoms appear, options for treating the problem may be less effective because the body is left with only limited defenses.
Lab studies and blood analysis
a) HIV-antibody testing
b) CD4+ cell testing
c) Viral load testing
d) Basic blood tests
Advantages
Indications of illness show up before illness becomes apparent. The tests enable patient and doctor to act to prevent serious infections before they occur and to act on the basis of hard numbers, not just guesses.
Disadvantages
It is difficult to act on test results, since you often feel fine no matter what the lab numbers say. People who feel healthy may be less motivated to begin treatment. Test results are variable, changing for many reasons.
Because HIV infection can be a life-or-death matter, it is critical to choose the second approach. Taking a preventive approach makes it possible to:
· use treatments when they are most effective
· prevent the most serious infections
· slow the rate of disease progression and permanent damage to the immune system.
Some people say they hesitate to act before they are sick because today's treatments are not perfect, hoping to wait for something better to come along. However, no one knows when perfect treatments will become available. It is now well proven that today's treatments can extend survival time. Although we can't predict the results in every case, we do know what generally happens without treatment.
The purpose of preventive action is to slow the progress of HIV. Once infected, you have one chance to manage HIV disease correctly, so consider your options carefully and learn how to tell if a therapy is working for you. A preventive approach is the one which seems to offer the clearest hope.
CD4+ Testing
For many years, testing the number of CD4+ cells was the most common way to measure the effects of HIV disease. Low numbers of these cells (below 200) accurately predicts the risk of major infections. The meaning of test results in between this critical level of 200 and the normal level of 1000 is unclear. Physicians once typically started treatment for people when the CD4+ was below 500, but this was always an arbitrary number simply selected from clinical trials. By itself, this number doesn't tell us enough about the state of disease. It only shows that the level of CD4+ cells is below normal, to varying degrees. Getting the full picture of HIV disease requires additional tests, especially the Viral Load Test.
CD4+ Cell Ranges
Low Medium High
(under 300) (300-500) (500 plus)
High Range:
In general, a CD4+ count above 500 suggests no immediate danger, even though it may represent a loss of half the normal CD4+ cell count (1000). The 500 level is sometimes cited as the bottom of the "normal" range, but this can be misleading. While an occasional drop to 500 may be normal, a steady or falling count of 500 or even 600 is not normal and indicates suppressed immunity. At the very least, dietary counseling, nutritional supplements, CD4+ cell monitoring, and periodic use of other tests are recommended in this range, whether or not treatments are used.
Medium Range:
CD4+ counts in this range indicate significant decline of the immune system. However, serious symptoms are uncommon in this range. Some researchers believe this is the optimum time to begin treatment, especially if the viral load test also indicates significant viral activity.
Low Range:
CD4+ counts below 300 indicate the greatest risk of infections and according to the 1993 definition of AIDS, a CD4+ count of 200 or less constitutes an AIDS diagnosis. A person with counts below 300 CD4+ may remain stable for many years, especially with careful health management. While some people have warning signs in the form of symptoms before major infections occur, this is not always the case. Some progress directly from apparent health to serious OIs.
It has become common to put people with CD4+ counts below 200 or 300 on preventive treatment against PCP (for example, Bactrim/Septra), along with all people who have already suffered an initial bout of pneumocystis. Prevention strategies for all of the common opportunistic infections are described in the Project Inform's Opportunistic Infections Chart. Regardless of CD4+ cell count, yearly monitoring for tuberculosis is becoming increasingly important.
Viral Load Testing (PCR)
In recent years, tests have become available which directly measure the activity of HIV in the blood. These tests gives a more accurate picture of the rate of disease progression. There are two commonly available tests for measuring viral load. One is called "quantitative PCR" (or "Q-PCR"), the other "branched DNA" (or "b-DNA"). Though there are small differences between the two tests, they are for practical purposes one and the same.
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Comments
HIV and AIDS Min Arot | Aug 25th, 2003
You have written an excellent text that is informative without being too technically for the non-scientific minds. I wish that you would get an opportunity for wider dissemination of the article in african journals and media so that more people may know these pertinent details about HIV and AIDS. There's also a French journal called Remaide which specializes on HIV and AIDS which could publish this article. Thanks and all the best.
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