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I would like to start meds!
Mar 15, 2009

Hello,

I was infected and diagnosed with HIV just over 2 years ago now. My CD4 then was 1200 and VL at about 100 000. My recent bloods have been between 540 and 650 for CD4 and VL has gone down from the 40 000 it was at 6 months ago to 24 000 now. My percentage has been hovering around 21%.

I know that recent talk has been about starting medication earlier than even the fairly new recommendation to start at a CD4 of 350. My doctor doesn't feel that this would be a time to start and I am just worried that I continue to put my immune system at further risk by just continuing to wait it out; especially since my CD4 was 1200 to start. Fatigue has definitely been an issue as well.

Despite everything, I am continually trying to improve my numbers by working out, eating healthy, trying some supplements and living a balanced life.

Would you consider starting meds at this point??

Thank you sincerely for your time!

Response from Dr. Holodniy

I certainly understand your doctor's perspective. I assume your CD4% was higher when your CD4 count was 1200. So taken together, the CD4 count and percent decline are likely real, in the face of an ongoing moderate level viral load. Although the guidelines recommend starting at 350, they also indicate in those with viral loads > 100,000 and CD4 counts > 350, that treatment should be considered. In addition, these are guidelines and not hard and fast rules, so starting HIV treatment will always be patient specific. I don't think there is an urgency to start, but if on the next set of numbers your CD4 count or percent has slipped a bit more, I would be inclined to recommend treatment, even if your count is > 350.



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