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sti guidelines
Jun 30, 2002

I'm considering an sti with my doctors monitoring.I do like the fact that the smart study provides for close clinical monitoring,the two things that are holding me back are the randomization,coin toss of which group you'll be)and the bottom cd4 level 250(too low for my confort)So,I want to formulate someting with my doctor.Since my count was always anywhere from 750-1200,mostly coming back in 900's, I think 400 would be my bottom confort zone.What about vl I heard it will spike and reset after dxing meds,but what if it doesn't? Also what is a safe "upper limit" to mantain? Do the cdc treatment guidelines apply here also ?Finally how long do you think it would be for me to bottom out at 400 with a starting point of 900,if I dicontinue while undectable and with a cd4 pecentage of 43 and ratio of 1.65.On treatment over 5 years. Thank you for you opinion.

Response from Dr. Young

Thanks for the questions.

I share your concerns about the design of the SMART trial; but I think that the study concept is very interesting. The protocol for monitoring viral loads and CD4 counts should provide a reasonable outline for someone wanting to do treatment interruptions, but not on protocol (not something that I recommend, wholesale).

There are no CDC or DHHS guidelines for managing interrupted therapy, but I think that the parameters still provide guidance-- that is to say, that the risk for certain types of complications are the same whether on continuous or discontinuous treatment.

You say that your CD4 count has never been below 750-- this would assert that in the current treatment era, you might not have ever started on therapy. This would likely make you the most ideal candidate for stopping therapy. Yes, the viral load should rebound to near baseline levels after stopping. The time it will take to have your CD4 cell count decline to 400 will depend on how high your viral load is-- the higher the VL, the faster the decline, on average. I'd venture that it will take over a year or more for this to occur, if your viral load is average (around 50,000).

Hope this is helpful. Good luck. _BY



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