Hello Dr. Congratulations for this site, I have read many posts and have found your answers very useful, thank you . I have been dignosed HIV positive a couple of days ago, and I am still coming to terms with it. My VL is 4000 and CD4 260 my HB 11 and hematocrit 34%. I have been told that I must start treatment. I had rather hoped that it woul be a while before that, since I do not feel ill. Regarding anaemia, would it correct itself just by having hiv treatment?..my iron levels are normal, although transferrin is a bit high and ferrtin borderline. One last question is one Vl and CD4 count enough to decide to start treatment? or should the test be repeated? Thank you for your help regards Paco

Hello Paco,

Anemia associated with HIV disease can have many causes, including so-called anemia of chronic disease, which is due to HIV itself. At this point your anemia is mild and it appears you've had a basic workup looking for iron deficiency, etc. Effective combination antiretroviral treatment could improve or resolve your anemia problem. If not, additional workup would be warranted.

As for beginning combination antiretroviral medication, the current guidelines suggest starting treatment when the CD4 count falls to 350. Information recently presented at HIV conferences suggests that starting even earlier, at CD4 counts of 500 (or above), has significant health benefits (protecting immune function, decreasing immune activation, etc.). Should you begin treatment after a single CD4 and viral load test? Personally I like to have at least two values to rule out laboratory or clerical errors. In addition it is beneficial to check an HIV genotype resistance test before beginning treatment. If indeed your CD4 counts are persistently below 350, I would certainly encourage you to start treatment. As an immunologist I would have suggested that optimally you start quite some time ago.

Good luck Paco. I'm here if you need me.

Dr. Bob