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The Latest Stories By John McCullagh

  • The PEP experience — Daniel’s story
  • The PEP experience — Raj’s story
  • PEP can stop you from getting HIV: A conversation with ACT’s Duncan MacLachlan
  • When to start HIV treatment
  • The AIDS Generation — Stories of Survival and Resilience

John McCullagh

John McCullagh

John McCullagh is the publisher of PositiveLite.com. He's an HIV-positive gay man who’s been active in Toronto's LGBTQ community since immigrating to Canada from his native Britain in 1975. A social worker by profession, he's worked in government and the not-for-profit sector in both front-line and management positions. His experience includes research, policy analysis, strategic planning, program development, project management, and communications. 

In the early years of the AIDS epidemic, John was a counsellor at the Toronto Counselling Centre for Lesbians and Gays (now known as David Kelley Services), an organization he co-founded and which was one of the first agencies in Toronto to offer professional counselling to those infected with and affected by HIV. 

Now retired, John volunteers with the AIDS Committee of Toronto (ACT) and is a board member of CATIE, Canada’s national HIV and Hepatitis C knowledge broker.  

John regularly contributes articles to PositiveLite.com about his personal experiences of living with HIV and about issues relevant to Canada's HIV and LGBTQ communities.

Mar06

When to start HIV treatment

Thursday, 06 March 2014 Written by // John McCullagh - Publisher Categories // OHTN OHTN/PositiveLite.com, Conferences, Treatment Guidelines -including when to start, Events, Features and Interviews, Health, Treatment, Living with HIV, John McCullagh, Ontario HIV Treatment Network

In a video interview, publisher John McCullagh talks with Toronto HIV primary care physician Colin Kovacs about the vexed question as to when to start treatment.

When to start HIV treatment

When to start HIV treatment? It seems there’s no consensus and, as far as most of Canada is concerned, no guidelines either. It used to be - and often still is - that starting treatment was recommended only when our CD4 cell counts had fallen to a certain level — 200, or 350 or 500. Yet those numbers keep changing and vary between jurisdictions. The Americans have tended to be more aggressive about recommending treatment at higher CD4 numbers, while the Europeans have, for the most part, been more conservative. In the absence of national guidelines (Québec and British Columbia have provincial ones), Canada has tended to follow the U.S. lead. 

The arguments against early treatment are familiar and are nicely summarized in this recent CATIE article. Yet many guidelines, including the American ones, increasingly call for starting treatment shortly after diagnosis, regardless of CD4 cell count. This is because many experts believe that starting treatment early has many positive long-term health outcomes. 

To address some of the complexities of this issue, I asked Colin Kovacs, an HIV primary care physician in Toronto, when he thought was the best time for someone living with HIV to start treatment. I caught up with him on the sidelines of last fall’s research conference of the Ontario HIV Treatment Network and you can watch our conversation in the video below. 

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