|HIV+ Proactive Medical Care
Aug 13, 1999
I have been HIV+ for 10 years, My T-cell count has always hovered around the 300-445 range over the 10 year period. Currently it is 369. My viral load I'm told is considerably low at 7,000 (The Highest it has ever been). Currently, my doctor advises that he sees no need for me to begin any type of combination therapies. I just go regularly for blood tests and monitoring and otherwise no treatment has been recommended to me outside of the normal preventative type things: flu shots, anti-biotics, and anti-virals when infection first occurs. Does this sound normal to you? Should I seek another doctor? Or do you think I am receiving this kind of low-treatment because I have not been employed (basically health program assisted)? ****I do have full healthcare coverage through my wife*****
Response from Dr. Remien
Let me start off by saying I am not a physician. However, I am willing to share with you my opinion based on my experience with many physicians specializing in HIV care and their patients. The care you are receiving DOES sound normal and sounds like good care. There are currently differences of opinion among physicians and treatment advocates about when to initiate antiviral therapy, because studies have not been designed and conducted in ways that can provide a good answer to this question.
The reason I think you are getting good care is that you are closely monitoring these clinical markers (viral load and T-cells) and you are getting good preventive care. Because your clinical markers are stable many physicians would agree that you do not need to do anything else at this point in time. If you were to see significant changes in these markers (a large rise in viral load, a significant decline in T-cells), on more than one test, that would be a time to think about initiating antiviral therapy.
Some people, along with their doctors decide to initiate therapy early (even when viral load is low and T-cells are stable) because they don't want to risk further damage to the immune system. However, there are potential problems with that strategy because antiviral therapies can be very demanding, have significant side effects, and may cause long-term toxicities. Thus, there are advantages to waiting as long as possible before initiating therapy.
Bottom line: if you are uncertain about your care and treatment strategy you may want to seek a second opinion and/or ask the advice of other HIV treatment specialists. There are no clear-cut definitive answers, but you need to be informed and feel comfortable with the choices you are making.
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