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high T-cells high viral load

Feb 12, 2006

I have been at odds with my ever changing physicians and PA's over whether to start meds at a high viral load even though I have a continued high T-cell count (1219 last visit). I have been positive now for 13 years. I started meds in 1998. My t-cells were 1100 but my viral load was 315,000 at that time. (my current physician doesn't think I should have started them then) I took meds for 4 years combivir then Ziagen and then Trizivir)..My new physician suggested I go off meds since my t-cells were high around 1500. Three years later, now my find my viral load beginning to increase significantly (149,000 last visit). I don't want to wait until I have low t-cells to return to meds but my physician thinks I should wait until it gets to around 300. I am concerned about "chronic activation of the immune system" or the problems that can result from a high viral load. I have heard about the risk of anal cancer. I also want to keep my t-cells as high as possible and not take the risk of depleting them and not getting them back. Shouldn't I go back on meds to get that viral load down?

Response from Dr. Holodniy

You don't indicate what your viral load was prior to the 149,000 reading. Was it undetectable or was it 25-50,000, and has it been stable and this is an acute jump? As you know starting or maintaining treatment is a balance between potential for long term toxicities from meds and the need to restore immune system function with treatment. Given where your current CD4 count is, there is no compelling argument to start immediately, even with a viral load of 149,000. My approach would be to keep the option open and see where the next few sets of numbers go.

Viral load increase even though CD4 is on the rise
Understanding the percentages

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