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24 years poz/no meds until now!!
Jan 23, 2011

I am hiv poz sinnce 1987,never on any meds .I am 46 and my CD4 are 490-520 for the past 10 orso yearswith a viral load of 2200.My doctor of the past 3 years has been encouraging me to start on Atripla I am leary because I fear that it could change what ever has kept the virus dorment could be altered and be come more agressive . Am I over conserened. Please help me make this decision

Response from Dr. Frascino

Hi,

Only you can decide when to begin antiretroviral therapy. Certainly your doctor and/or I can provide you with our opinion plus information supporting our opinion, but you will have to make the ultimate decision. It appears that your HIV infection has remained quite stable over the past 24 years with good CD4 counts (a measure of your immune integrity) consistently in the range of 490-520 and a reasonably low HIV plasma viral load of 2,200. Consequently, an argument can be made for holding off on antiretroviral therapy (ART) and continuing to monitor your CD4 count and viral load every three months. This is perfectly reasonable, particularly if you are feeling leery about starting or just don't feel "ready."

That said, there is also increasing evidence that chronic untreated HIV infection can cause immune inflammation, which can result in medical problems going forward. ART can help decrease HIV replication, decreasing the risk associated with unchecked immune inflammation. ART has also been shown to preserve immune function. These beneficial effects of decreased immune inflammation and preserved immune function need to be weighed against the potential negative consequences of beginning therapy including side effects/toxicities, cost and inconvenience associated with ART.

I would suggest you continue to seek out additional information about ART and various opinions about the optimal time to commence treatment. This Web site and its associated links have a wealth of information on this topic. I see no urgency for you to begin treatment; however, I, too, would lean toward the treatment option.

Good luck. I'm here if you need me, OK?

Dr. Bob


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