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High viral load AND high cd4 count, 5 years
May 10, 2009

I recently started dating a beautiful man that I am very interested in starting something serious with. He disclosed to me that he is positive very early on and I'm still trying to decide whether or not to continue by weighing all the relevant information and understanding what all the numbers he gives me actually mean for both his health and my own (I am negative and fully intend to stay that way). He's told me that he has a CD4 count of about 800 (which, I understand, is comparable to a healthy hiv- person) but a viral load of over 100,000 (which, from what I've read, is often grounds to start ART). He has never taken ART meds and has been healthy for over 5 years since the infection.

What are your thoughts on encouraging him to start treatment for prevention, in conjunction with safer sex, with these numbers in mind? Based on the current research, would it be good for his longterm health if he started treatment now even with high CD4 and good health for so long? And just how toxic and burdensome are pill regimens today? Is it possible that his immune system is somehow immune to the virus, even though the viral load isn't being suppressed? I want to have this discussion with him, and I want to be sure that we're both well informed when we do.

I know that's a lot of questions, but I hope you have a lot of answers for me. Thank you for your time, I really appreciate all of the great information I've found on this site.

-D

Response from Dr. Holodniy

Sounds like you have done your homework and have a good grasp on the issues. Someone with a viral load over 100,000 consistently will not maintain a CD4 count of 800 for the long term, and that level of viral load puts one at greater risk for transmitting the virus. In the short term there is no urgency for starting HIV treatment with that high viral load and that CD4 count. Yes, there are considerations about long term toxicity of HIV medications which must be weighed against starting now.



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