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re: sti guidelines
Jun 30, 2002

Dr. Young, I wasen't completely clear on my previous post on the cd4 levels and it is pertinent.The 750-1200 numbers were while on treatment.really their was maybe one or 2 around 750 and 3 or 4 over 1000 the rest always came around 900.This was during continuous treatment and (very long story)VERY unorthox year of substanstially self imposed reduced dosages(I know VERY BAD and I would never attempt this on my own again)but by some miracle it did not result in any resistance(how this happened is beyond me)this was a while ago and everything has been and is currently fine.The point I wanted to make was treatment naive my cd4 was quite lower, the absolute lowest was around 400.So does this make me less than "ideal".I know there are alot of other criteria involved and of course I will consider all with my practioner, but how does the 400 number pre treatment affect your thoughts?(P.S. it wasen't always 400 it just naturally declined over a few years of monitoring from probably somewhere mid 600's)Thank you.

Response from Dr. Young

The 400 CD4 count probably doesnt dramatically change things, since it is still above the level at which many would recommend starting therapy.

Yes, self-imposed dose reductions are a really bad thing, since they can place you at significant risk for developing drug resistance.

One important, but theoretical area to consider is how to best stop therapy-- that is to say that the general goal is to have all of your medications leave your body at the same time; this can be challenging, since some drugs have different half-lives in the body (efavirenz or tenofovir, for example). Make sure that if you ultimately decide on stopping, that you ask your healthcare provider for advice on how to best stop medications.


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