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How far can I go?
Dec 18, 2000

First of all thank you Dr. Holodniy for having this forum for HIV/AIDS questions, trust me you are doing a great service to a great many of people. I am a government employee and lately due to the recent elections I have become very busy at work. During this time I have been on a drug holiday. Matter of fact I have been on this holiday well over a year. I recently switched doctors, after an intern from my last doctor told me to "suck it up" and deal with my HIV. Since I have been with a new doctor, I went back on my meds, but I simply cannot take them. They are too strong, too demanding, for me to deal with. Since I was diagnosed HIV Positive in 1998, I have been on at least 8 different types of Meds. All of which I could tolerate for a long time. My Viral Load as of November 2000 is 45,000 and my CD4 is 260. I asked my doctor if I could remain on the "drug holiday" until next spring, he said my percentage was at 24%, so he thought it would be okay. But he thought I should come in at least once a month until that time to check on my blood counts. Dr. Holodniy, I have (2) questions, (1) in your opinon, how far can I go without taking meds before I begin to experience AIDS complication illnesses? (2) If my CD4 goes 200 or below, and I am told I have AIDS, and if I go back on the meds and if my counts begin to show progress, will I be considered to have AIDS or HIV?

Response from Dr. Holodniy

Your percentage of CD4 cells is quite good and higher than what your CD4 absolute count would indicate. You buy the AIDS diagnosis below 200. It is a very individual thing regarding who develops AIDS associated complications and when. The definition of AIDS depends on whether you are discussing biologic or financial/insurance/benefits definitions. Biologically, if you dip below 200, and then go back up after treatment, you are out of the AIDS region of severe immune deficiency. Given that viral load it is not if, but when, your CD4 count and percentage begin to decline. Your doctor is being cautious and wants to see the trend and follow it closely.

MH



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