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Should I Be More ProActive?
Jan 27, 2013

I was diagnosed HIV+ in 1999. For the first few years I was pretty diligent and responsible about seeing my HIV specialist. My labs were always basically the same. My viral load was always less than 1000 and my CD4 count was always between 550 and 700. No meds were recommended. After about about five years I went less often to my doctor. After a two year lapse my doctor "fired" me for non-compliance. Since then I have continued to get a viral load test and CD4 count annually from a general practice physician. I just request the labs and take note of the results. Its been 14 years and my labs are still the same. No change. As long as this trend continues, do I need to get another HIV speacialist or can I just keep getting an annual test independently as long as things don't trend downward.

Response from Dr. Holodniy

Well you certainly have time on your side, and enough so to have a pretty good sense of where the trend line is. There is no consensus among experts about what to do in a case like yours. If you walked in today with a new diagnosis and those numbers, half the experts would say you don't need treatment and half would say start treatment now, regardless of where the CD4 count and viral load are. Today, thinking has changed and most experts think (and the guidelines reflect) that regardless of the counts people should start HIV treatment to preserve immune function. You are to be commended for at least continuing to get your numbers along the way. Many patients drop out and come back 5 years later to see that there CD4 count has dropped in half and the viral load has increased. Given your stability and longevity with HIV infection, there is no urgency still to start HIV meds. However, what we don't know and can't measure that well is how much your immune system has been compromised by a steady but low level of viral replication for 14 years. In other words, your may still have a CD4 count of 700, but do they still work as well as they did before you were infected. Starting treatment now would eliminate this variable from here on out. But how necessary that is right now in you is the question.



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