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infected 4 months..
Oct 7, 2002

hi dr. wohl - by the way, YES your name means "well". i know, i am german :-) my question would be: i am positive for a little over 4 months now. i know for sure because i know whom i got the virus from. my current (1st time measured) VL is 400.000 and cd4 is at 500. could you tell the probability of not having to start therapy anytime soon because VL and cd4 develop "in a positive way" ? are there statistics that show therapy-starting-points in relation to infection-time ? thank you very much and best wishes from germany

Response from Dr. Wohl

Hi-

In studies of HIV positive men who had a viral load and CD4 cell count drawn and were then followed for several years, those with the highest viral loads, regardless of CD4 cell count, had very high rates of progression to a diagnosis of AIDS or death (i.e. >70%). The higher the viral load, the greater the risk of disease progression. Therefore, statistics would predict that your high viral load of 400,000 places you at great risk of seeing your CD4 cell count drop over the next couple of years and a high likelihood of AIDS soon after that.

There have been a few shorter term studies that have looked at what happened to people who started HIV therapy at a range of CD4 cell levels. In general, these studies indicate that in the near term (2 years) there was little to be gained as far as survival is concerned by starting treatment when the CD4 cell count was above 200-350. Now, some smart people disagree with this and believe that earlier therapy will be demonstrated over longer periods to be more beneficial but we need more research since the risk of side effects needs to be balanced with any delay in HIV progression.

Currently, I think the hitting later rather than earlier strategy we have embraced is justified. As drugs become less toxic and easier to take, the calculus may shift toward earlier therapy again. If I was your doctor, I would follow your counts a for a stretch of time and see where your CD4 levels are headed. Statistics can only estimate what you, the individual, will experience. You may surprise us. If your counts are headed downward rapidly, I would recommend you initiate HIV therapy. If not, I'd wait and see. Best of luck - DW


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