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Confusing Recomendations
May 18, 2013

I have been HIV+ for 14 years. I have never taken any HIV medications. Over that time my labs have been the same. My viral load is always below 1000 and my CD4 count hovers between 600-800. I have read that now treatment is increasingly advised for anyone diagnosed HIV+. I wonder if this would really benefit me. I am healthy. Why should I choose to start treatment? Is there really a significant difference between a viral load of 500 and an undetectable load? As a public health issue, I understand that if people are treated for HIV, they are less likely to transmit the virus, but in my case would this really be true? I am responsible and practice safe sex regardless. I have also heard that even though my CD4 is in the "normal" range, my T-cells may not be as effective because of HIV infection. Has research demonstrated this, or is it simply a theory? The cost of meds is a big consideration also, even with insurance. I know the side effects of HIV meds are less dire than in the past, but even now I read about bad dreams, loose stools, and yellowing of the skin and eyes, even with the best treatments. I would prefer to just keep an eye on things and wait as long as possible, but there seems to be a rising tide of opinion that everyone should be on meds. Is this truly in my best interest? I don't want to be cynical, but I worry that these recommendations may be informed more by public health concerns and/or drug company greed than in the health outcomes of individual patients.

Response from Dr. Holodniy

You raise important questions and issues. Although current guidelines suggest that people with HIV infection should be on HIV treatment regardless of CD4 count, the experts are split on this issue, and we don't have prospective, randomized trials in people with CD4 counts > 500 to answer this question. There is general agreement and data to suggest that HIV causes a pro-inflammatory state in someone who is infected and this can accelerate other conditions like heart and kidney disease. By starting treatment earlier and shutting viral replication off, you reduce the inflammatory aspects of the infection, as well as improve CD4 count and function.



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