4 ms·

It really is basically normal: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7296391/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7296391/ From 2011 to 2016,

by vore 4y ago

It really is basically normal: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7296391/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7296391/ From 2011 to 2016, overall life expectancy at 21 years of age for individuals with HIV infection who initiated ART at a CD4 cell count of 500/μL or greater was 57.4 years (95% CI, 55.7-59.1 years) and for uninfected adults was 64.2 years (95% CI, 64.0-64.4 years), corresponding to a difference of 6.8 years (95% CI, 5.0-8.5 years) The risk profile for a full bone marrow transplant for treating HIV vs HAART for a difference of ~5-9 years is just not there.

torstenvl 4y ago
> The risk profile for a full bone marrow transplant for treating HIV vs HAART for a difference of ~5-9 years is just not there. According to whom? Who gets to make the choice between 57 years of drugs and stigma versus 64 years of being cured?
- vore 4y ago
  Of course the patient ultimately decides, but you are really really downplaying the risks of stem cell transplantation: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202970/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202970/ Based on their 2010 alloHCT volume, centers were categorized as low-volume (≤40 alloHCTs; N=42 centers, 1,900 recipients) or high-volume (>40 alloHCTs; N=41 centers, 9,637 recipients). 100-day survival was 86% (95% CI, 85–87%) in high-volume compared to 83% (95% CI, 81–85%) in low-volume centers (difference 3%; P<0.001). One-year survival was 62% (95% CI, 61–63%) and 56% (95% CI, 54–58%), respectively (difference 6%; P < 0.001). You are literally getting a coin flip of surviving past 2 years after an allogeneic hematopoietic stem cell transplant. If I was given the choice of HAART and living a mostly normal lifespan, or maybe die with a coin flip chance in 2 years, I would pick HAART, no contest.
  - chimeracoder 4y ago
    > You are literally getting a coin flip of surviving past 2 years after an allogeneic hematopoietic stem cell transplant. If I was given the choice of HAART and living a mostly normal lifespan, or maybe die with a coin flip chance in 2 years, I would pick HAART, no contest. Not to mention that the "64 years" comparison is not the correct reference point here, because it's talking about people who were never infected with HIV in the first place, not people who have received a stem cell transplant. The stem cell transplant almost certainly reduces both your lifespan and QALS in the long term, not just the first two years. Yes, it might be worth it if you have cancer, but it's not like it suddenly makes you clinically equivalent to a person who has never had HIV!

by vore 4y ago

torstenvl 4y ago

> The risk profile for a full bone marrow transplant for treating HIV vs HAART for a difference of ~5-9 years is just not there. According to whom? Who gets to make the choice between 57 years of drugs and stigma versus 64 years of being cured?

vore 4y ago
Of course the patient ultimately decides, but you are really really downplaying the risks of stem cell transplantation: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202970/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202970/ Based on their 2010 alloHCT volume, centers were categorized as low-volume (≤40 alloHCTs; N=42 centers, 1,900 recipients) or high-volume (>40 alloHCTs; N=41 centers, 9,637 recipients). 100-day survival was 86% (95% CI, 85–87%) in high-volume compared to 83% (95% CI, 81–85%) in low-volume centers (difference 3%; P<0.001). One-year survival was 62% (95% CI, 61–63%) and 56% (95% CI, 54–58%), respectively (difference 6%; P < 0.001). You are literally getting a coin flip of surviving past 2 years after an allogeneic hematopoietic stem cell transplant. If I was given the choice of HAART and living a mostly normal lifespan, or maybe die with a coin flip chance in 2 years, I would pick HAART, no contest.
- chimeracoder 4y ago
  > You are literally getting a coin flip of surviving past 2 years after an allogeneic hematopoietic stem cell transplant. If I was given the choice of HAART and living a mostly normal lifespan, or maybe die with a coin flip chance in 2 years, I would pick HAART, no contest. Not to mention that the "64 years" comparison is not the correct reference point here, because it's talking about people who were never infected with HIV in the first place, not people who have received a stem cell transplant. The stem cell transplant almost certainly reduces both your lifespan and QALS in the long term, not just the first two years. Yes, it might be worth it if you have cancer, but it's not like it suddenly makes you clinically equivalent to a person who has never had HIV!