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Should I start meds? My VL is already "undetectable"

Nov 6, 2011

I was infected in Oct'06. Diagnosed in Dec'06. Modest seroconversion symptoms including mild Neuropathy in left hand/arm. Not on HAART. Health good. I am 50 years of age.

Tested every 3 months. Results as follows: Dec 06: CD4 298 (28%) VL 276; Jan 07: CD4 598 (28%) VL not tested; Apr 07: CD4 443 (28%) VL undetectable; Jul 07: CD4 398 (29%) VL undetectable; Oct 07: CD4 466 (32%) VL 70 copies; Jan 08: CD4 369 (29%) VL undetectable; Apr 08: CD4 445 (??) VL 131; Jul 08: CD4 359 (??) VL 131; Oct 08: CD4 518 (??) VL 108; Jan 09: CD4 351 (29%) VL undetectable; Apr 09: CD4 results lost VL 255; Jun 09: CD4 497 (27%) VL not tested; Jul 09: CD4 411 (25%) VL undetectable: Oct 09: CD4 426 (27%) VL 55; Jan 10: CD4 294 (27%) VL undetectable; Apr 10: CD4 369 (28%) VL undetectable; Jul 10: CD4 335 (27%) VL undetectable; Oct 10: CD4 358 (29%) VL undetectable; Jan 11: CD4 460 (32%) VL 86; Apr 11: CD4 343 (28%) VL 61; Jul 11: CD4 500 (23%) VL undetectable; Oct 11: CD4 312 (??) VL undetectable.

Have discussed the less than normal CD4 counts with my doctor and starting treatment. Given the goal of HAART is to reduce the VL to undetectable, we have discussed delaying since it is already there. My doctor also points to the pretty good CD4 percentages. He is still open to delaying (in fact, we are doing another set of tests in November). Of courese, I would like to avoid meds for as long as possible and safe, but I am wondering if the time has come? I know there is some thought that "earlier" is now better especially as the meds are more tolerable. Additionally, for the first time since my seroconversion I have had a bit of mild Neuropathy again in my left hand/arm and lower leg.

Thanks for your time and comments.

Response from Dr. Holodniy

It would have been good to see the CD4 percent from the October 11 result. If it was 23% or lower, then I would likely be favoring starting treatment. So the November test will be important to see whether your CD4 percent and or CD4 count are back up or are now in the 300 and low 20% range. If the latter is true I would recommend treatment, even with an undetectable viral load.

Viral Load Increasing
CD4 count crashing quickly

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