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Op-Ed

On starting antiretroviral therapy early

An HIV-positive Filipino who has an HIV-negative partner wants to know if he should already start taking treatment. Dr. Jose Narciso Melchor Sescon provides needed information on this.

Dr. Jose Narciso Melchor Sescon – president of the AIDS Society of the Philippines and current Chief of Clinics of Sta. Ana Hospital – answers all your HIV-related inquiries. For all your questions, email josescon1@gmail.com or info@outragemag.com.

Dear Doc,

My CD4 is still over 600, but my doctor is recommending that I start ARV because I’m in a serodiscordant relationship (that is, my BF is negative, while I am positive). I am apprehensive doing so because I know that when I start taking meds, it will be for a lifetime. How should I proceed here?

Medically Confused

The eligibility of a client to start ARV or not depends on the current national ARV guidelines/protocols approved for implementation by the Department of Health (DOH). It is important to check first what the guidelines state, most especially when dealing with serodiscordant couples.

Countries with a more generalized epidemic or those countries that have reached maturity in terms of the HIV epidemic, ARV treatment algorithms, combination therapies, and supplemental therapies may have different approaches from our current country recommendations.

For consideration are conditions that some HIV clients, or serodiscordant couples who are entering a clinical trial that warrants deviations from what the current national ARV guidelines/protocols state. This has to be understood.

So how to go about in this situation?

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A) Check out for the latest ARV guidelines/treatment protocols of the country, most particularly with dealing with serodiscordant couples. Ask a current health provider should the guidelines/protocols not be available.
B) If there are no specifications mentioned about this, the high probability is that the serodiscordant couple is entering a clinical trial. So discuss in full length the details of the intervention and what to expect after the entire duration of the trial. It is important for everyone to know that when any client is entering “clinical trials”, there is an informed written consent signed and the right to discontinue at anytime if the client wishes to.
C) Ask a knowledgeable and reliable HIV counselor from the treatment hub if these are commonly conducted among serodiscordant couples. This is another way to cross validate information obtained from other health providers.

When in doubt, ask around among reliable HIV health providers. Do research.  Locally, and at the end of the day, what is still the best methodology to prevent HIV among discordant couples is the consistent correct condom use. Until such time that with ARV intake (pre/post exposure prophylaxis) guidelines have been formulated, this is accepted and recommended for local adaption.

New advances in the biomedical field have demonstrated successes in reducing HIV transmission among discordant couples, namely pre-exposure prophylaxis and ARV for prevention. These prevention methods are still in infancy stage in the Philippines, and their real-life applicability is currently being reviewed, but they could prove to be valuable prevention methods in the future.

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