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Should I start treatment?
Apr 21, 2002

I found out I was HIV positive in 92, and I was most likely infected in the same year. My t-cells have slowly fallen over the years from over 900 when I first found out to 348 in Jan of this year. My viral load has always stayed between 1000-5000 and my current percentage is 25. My question is should I start treatment or could I wait a little longer? I was thinking that since my viral load is kind of low, I most likely wasn't at a high risk for an OI? Or am I?

Response from Dr. Young

Thanks for your question.

You are correct in the assumption that your risk of having an opportunistic infection currently is quite low. Nevertheless, persons with CD4 counts around 350 (your percentage of 35 is consistent with this level) are at increasing risk of having complications with further decreases in CD4 counts.

There is, however, no emergency in starting therapy. The decision as to which combination to begin depends are a number of factors, and your low viral load would suggest that just about any three drug combination should work very well (including simple 3-NRTI combos). I'd certainly would want to repeat your numbers, just to make sure that we were not rushing into things; since you were infected in 1992, there is low risk of having acquired drug resistant virus (and certainly not NNRTI or PI resistance); though for others, more recently infected, I've recommended getting baseline genotypes to assist with treatment selection.

I'd also suggest consideration of clinical studies-- persons who are treatment naive are an extremely valuable resource to learn about how particular treatments work; and if appropriate, may also offer benefits to you. If your interested in this later option, I'd contact your local ACTG or CPCRA site.

Hope this helps, BY


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