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Mar 1, 2008

Dear Doctor I am a constant reader of your site, I am 61 YOA. I live in Thailand and my doctor here is still under the impression that I should not start on medication until my CD4 count goes down to 250, this is after I showed him a print out of your recommendations to start meds above 350 which is now recommended by the U.S the UK and Europe. He stated that they have not been informed of these new figures by the Thai medical board to date.

I am a bit worried as I was diagnosed to be HIV Pos in August 2006, CD4 = 553, V/L = 200,000. Feb 2007, CD4 = 479, V/L = 264,000. Sept 2007, CD4 = 695, V/L = 500,000, Percentage 23%. Jan 2008, CD4 = 523, V/L = 170,000, Percentage 31%

I dont understand too much about the illness and am confused whether I should be on meds for the high V/L, or whether I should be on meds for CD4?

If I should be on either meds, what would you recommend, or what would you recommend I do. Worried.

Response from Dr. Holodniy

Your CD4 count and percent are still in the normal range, but your viral load is consistently very high. This is not a good combination to have for the long term. But having that high a viral load means your CD4 count won't remain that high for the long term without treatment. However, there is no urgency to start treatment now. But if you see the CD4 count and percent starting to slide below 350, I would start sooner rather than later to preserve your immune function.

When to start meds?
viral load 300

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