Question related to HIV

[stawberry]

Please don't shoot me if I've posted a silly question. it's just a random question asked by my tutor.

"A man who is HIV positive really wants a job and he doesn't want to reveal the fact of HIV positive to his employer. He is willing to take all risks and wonder when he could stop using the antivirals before blood test to avoid their detection in blood results."

I personally do not agree patient should stop using the antiviral and put himself to risk. I do not know if this question is sensible because I think the detection of AIDS is more related to antibodies against HIV instead of drug levels. Moreover, I think the blood test might be managed on 'opt-in' basis, i.e. patient consent is sought before HIV test is done, and this patient will not be known as HIV positive. I might be wrong. However, if we answer this question purely based on the pharmacology of drugs, I suppose the answer will relate to the half lives of the drugs?

I think this question might appear in real life situation; if this occurs, how would you counsel the patient? Will he be able to hide this from his employer even though he stops taking them?

I would certainly appreciate any responses. Thanks.

[crit care]

I'm not quite sure i understand the question....why would you want to do a blood test to detect drugs..surely you would have to perform numerous assays to detect the drug..there are quite a few HIV drugs out on the market..would someone really be prepared to assay for every possible HIV drug in order to determine which drugs are in his system.......

I wouldn't want to stop taking HIV drugs in order to pass a drugs test...The diagnosis of HIV is the viral load and CD4 count in the blood, and drug treatment usualy starts once the viral load reaches a certain level...

If he doesn't reveal to his employers he is HIV positive then they are none the wiser?? surely!

To check if someone is HIV positive, i wouldn't go detecting drug levels..i'd test viral load. Also depends on the job..some more high risk than others!

Not really answered your question but hopefully tried to reason it out?!?

[bobbin]

What sort of employer tests for HIV medication? A small proportion of occupations may require a 'drug screen' for drugs of abuse, but this certainly won't detect antivirals.

[browneyed_girlksk]

Strawberry:

Your first instinct is correct - he should definately NOT stop his HAART. The uneoquivocal test for determination of HIV status is an antibody test (not antiretroviral drug levels, not CD4, not viral load). If a patient has elected to be on HAART, then compliance is of the utmost importance, the most recent thinking is that strict compliance with fully-supressive HAART will lead to an undetectable viral load - which in addition to keeping you healthy for longer, drastically reduces the likelihood of transmitting the virus to someone else. Taking breaks from therapy might also compromise the whole HAART regimen and increase the chance of resistance.....when stopping a regimen, most docs will tell you to ensure the whole regimen is stopped at the same time to prevent resistance from developing, but what isn't always considered is that if the regimen contains both short and long half-life (as with a NRTI+NRTI+NNRTI regimen) - stopping the whole regimen at the same time will actually lead to a period of NNRTI monotherapy (as the half-life is longer than the other drugs in the regimen)- which in turn increases the likelihood of NNRTI resistance and may cause the overall regimen to fail. As a result, taking a break from HAART has to be done under careful supervision.

PS - the reason to look for antiretroviral levels in the blood is for Therapeutic drug monitoring (ie - to adjust the dose, monitor drug interactions etc).

[erector]

I would like to know - does HIV affect erection, and can viagra help on this?

[erector]

Could you please send all reports to my email - removed for safety - don't post your email on a public forum!

[Sir_Dispensalot]

i suspect the above to be a spammer, with an ip from Tajikistan. one wrong move and he will be banned.

[johnep]

Yep, we await the usual advert blurb with interest. If erection not possible, would not be sexual transmission. Therefore question is ridiculous.
Perhaps castration could be considered as a public health issue.
johnep

[Nik]

Was an article couple of years ago in New Scientist suggesting circumcision in men in countries with higher prevalences of HIV infection led to a massively reduced risk of picking up the virus.

[johnep]

Well it would at least lead to equality in those countries where female circumcision is the norm.
johnep