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High Viral load and high CD4
Feb 14, 2001

Dear Doctor, I am HIV+ since Feb00 and I discovered it last june. My CD4 have been always high (930 - 750 - 860 - 907), but also my viral load (60k, 240K, 80K, 200K). I feel very well (from a health point of view) although also very depressed due to this situation. My doctor, from a specialized centre here in Milan Italy, has now offered me to treat the infection, but I am very sceptical. I know that there are different views about it and with such a high viral load I probably should be treated. My view is to continue monitoring my situation and unless of a sudden decrease of my CD4 level (below 500), to stay away of treatment. I also know that sooner or later I will have to start it, but in the mean time I will give research and pharmaceutical companies more time to find out more effective or less complicated treatments. Is mine a fair view? Would I risk anything by doing it? Thank you in advance for your answer. Regards, Alessandro

Response from Dr. Holodniy

We are beginning to rethink when treatment should be initiated. New guidelines for treatment initiation are just being released. In general these new guidelines state that treatment could be deferred until the CD4 count is <350, and the viral load is < 30-50,000 copies/ml. If your viral load is > 50,000, treatment would be recommend based on prior studies showing the risk of progression in this group is much greater. You fall in this group, and I would probably recommend you start sooner and not wait for your CD4 cells to come down. MH



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