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Starting therapy?
Jul 28, 2002

Hi, I have a couple of questions that I thought maybe you could help me with?????

I found out I was HIV positive in 1993 when I was 17 years old, and know that I was infected in April of 1992. My t-cells have slowly fallen over the years from over 900 in 1993 to between 345-410 this year. My percentage between 24-26 and my viral load has never been over 5000, last one was 752. My doctor says it is getting time to start taking medications. He is recommending something easy to take like Trizivir. My questions are, Do you think I could wait awhile longer before I started taking something? Could I get an Opportunistic infection at my current levels? Is my progressing average? Is there a chance that suddenly my t-cells could fall and my viral load shoot up?

Thanks so much and keep up the good work!

Response from Dr. Young

Thanks for the question and comments.

Would seem to me that you've had a fairly average rate of T cell decline over the past decade. You do indeed have a low viral load and this portends continued slow decline in T cells, but at a rate slower than average.

Many would begin to consider starting treatment in the near-to intermediate-term future; but recent studies have suggested even a greater delay in initation (though this is controversial, and I'm not sure that I entirely suscribe to the "start at 200" school). Other recent studies have suggested that the rate of certain HIV-related complications seem to rise with lower CD4 cell nadir (lowest ever)-- hence, delay in starting might place you at increased risk for things like lipodystrophy and neuropathy.

In the end the optimal time to start is an individual issue-- with your low viral load Trizivir (ZDV/3TC/ABC) would certainly be a potent, simple, low pill count and generally very well tolerated drug regimen.

Good luck, BY

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