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how to proceed?
May 17, 2002

hello doctors, The shock of testing positive three weeks ago is leaving and with the help of family, local support group and education i am beginning to (albeit stubbornly) prepare myself for living with HIV. Could one of you please respond. The BODY has been an excellent and graceful resource for me and countless others, to be sure. During a recent three week period I passed a kidney stone, during the hospital visit for that, my platelets were at 40k. Testing showed an enlarged spleen and a cat scan showed multiple small scarring on my liver. A lymphnode biopsy followed and shortly after i was confirmed HIV+. My oncologist tested cd4 and platelets again and they were 151 and 128k. I was also told that i am slightly anemic. My initial visit to my ID Specialist suggested testing and treatment for the above problems before considering MEDS. At that time my cd4 went to 374 (viral load not ready yet). I agree with her about waiting on Hiv Meds because i am not redy to deal with them yet. Would it be wise to wait on meds to see if cd4 decrease further or depending on the viral load results ie. start if high don't if not? I am 4 years clean and sober, don't smoke and could have a better diet and i am working on that and overall feel pretty damn good. I have not lost weight but have experienced diahrrea and some bronhial disturbanc. I now take Bactrim but nothing else. well, thank you

Response from Dr. Young

Thanks for your question and warm comments.

I never try to rush the decision to start HIV therapy (with the possible exception of persons with very advanced, symptomatic disease). Indeed, I try very hard to not make any clinical or therapeutic decision on the basis of a single lab test.

Hence, I think that waiting a little longer is not irrational. Now, if your CD4 count remains in the 350 or lower range, starting therapy in the near future is probably reasonable (irrespsective of your viral load). Remember, though that is makes a lot of sense to weigh all of your treatment options; make sure that your social and mental health are as good as possible-- I'd suggest learning about aids for making adherence as water tight as possible, for example. Then, when the time and space is right, starting therapy should have it's optimal outcomes-- long term durability and disease free survival.

Hope this is helpful, BY



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