HIV Treatments: An Interview with Jon Kaiser, M.D.
By Darren Main • Spring 2001
NOTE: Because this interview was conducted in 2001, standard treatments for HIV have changed and evolved. Please consider that as you read this article. Please consult your physician or contact Dr. Kaiser directly for the most up-to-date treatment options available if you our someone you know is HIV+.
Over the past few weeks, my email box has been flooded with questions about HIV treatment in response to the U.S. Government’s new recommendation that people with HIV wait to start Antiretroviral cocktails. As a result, more and more people are interested in learning ways to keep their immune system strong and healthy, so as to avoid these toxic drugs for as long as possible.
In an effort to answer all of your questions with regard to this new standard, I interviewed Dr. Jon Kaiser, author of Healing HIV. Part one of this interview deals with the use of drug cocktails.
D In your book, Healing HIV, you make an astounding claim that in the past four years, not one of your patients who had a CD4 count of greater than 300 has dropped below that number.
J Well, to make it more accurate, it would now be during the past six years. So it’s still held true and continued during the two years since I wrote Healing HIV.
D You also state that not one person who came to you with CD4’s greater than 50 has been seriously ill from an HIV related illness. What do you mean by seriously ill?
J Nobody who’s come to me with greater than 50 T-cells, and again that’s now during the past six years, has required any hospitalization or died from their HIV infection.
D You also make a really strong distinction between the words “healing” and “cure”. Could you say a few words about that?
J Healing is taking one’s level of health at a beginning level and raising it to a higher, stronger level of health. And oftentimes healing requires continued attention and continued intervention over time. Work on your healing program doesn’t end at any point. You have to keep working on improving your health. The term cure, by definition implies the elimination of any need for follow-up care related to a condition. So when I say healing from HIV, I mean people who have this condition going from point A to point B, which is a healthier, stronger place, but it doesn’t imply that they then can forget about it and no longer pay attention to it.
D When do you feel a person should start on the antiviral medication?
J I base it on three factors. First, what is the T-cell count, and how has it changed over time. The second is where the viral load is at the moment, and how that has changed over time, and the third factor is whether the patient has any symptoms that can be attributed to the HIV infection. So in my book, I state that there pretty much needs to be either a T-cell count which has gone below 300, a viral load which has gone above 50,000 and/or clear symptoms to the infection before I believe starting antiviral therapy is indicated.
D What are the current government suggestions for starting on the cocktail?
J They’re now at 350 T-cells and 20,000 viral load. They were at 500 before, so my numbers are still below theirs.
D How do you feel about HAART – (Highly Active Anti Retroviral Therapy)?
J Most people look at HAART as being triple combination – certainly in patients who are starting their initial program. So in the vast majority of people who progress to the point where they need to go on antiviral therapy, I will prescribe at least triple combination at this point in time.
In the past, in people who have had – let’s call it – mild HIV infection – a low viral load and T-cells at least over 300 – I have used a dual combination. In quite a number of people, and a percentage of patients that I follow are still taking just the two initial drugs that they started with.
In that subset of patients with mild HIV, who are also following aggressive natural therapies, I’ve averaged five years with two drugs before we need to consider making any changes. So that’s far above what the studies looking at two drugs show as the length of time that it works.
D Are there drugs that you tend to start with – that you feel have less side effects in general and ones that you avoid until the last resort?
J AZT is one of the drugs that I try to save for later because of its toxicity to the bone marrow. The bone marrow makes your T-cells. It’s responsible for providing red blood cell production, which ties into your energy level, and your sense of well being. And I also favor using the NNRTI class versus the protease, so my initial regimens are usually protease sparing. The reason for that is because protease inhibitors have more toxicity to the gastrointestinal tract and to the liver. I think that a person’s long-term health and immune function are very much dependent on the health of their bone marrow, their liver, and their GI tract. And so I’m going to try and choose medications that have less toxicity to those three systems.
D Some of the emails I’ve received have asked – “I did the hit hard, hit fast regime, and I never got sick, my T-cells never went down, my viral load was never really that high. Is it safe for me to stop taking the antiviral drugs now? Should I consider doing a drug holiday?” What is your opinion on drug holidays or stopping altogether?
J If there’s clearly toxicity going on, in terms of symptoms or lab tests, and the patient’s T-cell count is high enough to warrant a break from the medication safely, then I really don’t hesitate to give them that break. The term is Structured Treatment Interruption – STI – but really the S is better defined as “supervised” – Supervised Treatment Interruption because that’s really what it should be. You should be doing this under the supervision of your physician.
Let me define the two classes of people who I believe it’s safe or beneficial to stop taking their medications. One, people who have high T-cells but are exhibiting obvious toxicity, so they clearly need a break, and Number Two, people who have high T-cells who may have not needed to go on the drugs in the first place. So those are the two classes that I think can warrant [or] have some utility in taking an interruption.
D Is it possible that the virus could become resistant to the drugs by taking a “holiday”?
J Actually there’s been a large number of studies in the past year, looking at treatment interruptions. Nobody’s come up with a formula that works all the time for everybody, but what they have shown is that the virus does not appear to develop any higher level or higher frequency of resistance. Even if you go off and on the drugs several times, as long as you stop them all together and start them all together. So at least we know that it’s relatively safe in that respect.
D What do you think of the so called AIDS dissidents who believe that HIV is not the cause of AIDS and that it is drugs like AZT that are killing people?
J I believe that in general, the people in those groups are denialists, in that, it’s just very convenient to deny that there’s a viral infection that is causing damage to the immune system, and causing people to die. On the other hand, I believe that there are a few threads of truth in their message. And the threads of truth go back to the fact that when antiviral drugs are prescribed inappropriately, such as AZT 12 a day, they can poison people. And so I agree, that when prescribed inappropriately, these drugs are harmful. So I honor that part of their message. The other part of their message that I honor is that lifestyle and drug abuse and unhealthy behaviors can damage the immune system. And so I honor the fact that plays a role, but the scientific evidence is overwhelming that the amount of viral activity of the HIV virus is the major factor in whether the immune system gets weakened and damaged.
Dr. Jon Kaiser has a practice in San Francisco Bay Area and offers phone consultations for people living outside the San Francisco Bay Area. He can be reached through his website
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