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Should a long term non-progressor begin HIV meds?
Feb 26, 2012

I have been HIV+ for 14years without taking meds. Generally my CD4 is in 500-600 and a viral load of ~3000-7000 over the least 5years. I feel fine overall and rarely suffer from colds or flu or anything else for that matter. However, my physician is recommending that I start therapy do to inflammation risks of HIV. However I think I should test inflamation markers before starting therapy and only begin if these markers are showing hi degrees of inflammation. Otherwise I don't see a benefit to starting. I am currently 50 and was converted when I was 36. So two questions? Do you think I should start therapy? And if I want to measure inflammation what tests would you order? Lastly I here about vitamin D and that one should be tested for Vitamen D and perhaps take supplement to help immune system.

Response from Dr. Holodniy

The experts are split 50:50 as to whether people with CD4 counts > 500 should start HIV treatment. These decisions are usually about people who present for the first time with your kind of numbers. In your case however, time is on your side. If your numbers haven't budged for 14 years, I would be comfortable in continuing to watch. Your question regarding inflammatory markers is a good one. I am not sure what I would measure. Some people are supporting the use of C-reactive protein (CRP) which is now used to assess the risk of cardiovascular disease. There are a thousand "inflammatory" markers circulating in the blood stream but I don't believe this has been well dissected yet. Many with HIV infection, and older age, have been found to be vitamin D deficient. More data is coming out every day about the importance of vitamin D and the immune system. So a one time blood test is not unreasonable.



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