I found out in december of 1998 I was seroconverting. My first round of blod work came back t-cell count of 318, and viral load of over a million.

The second round of blood work came back a bit better, t-cell counf of 650 and viral load of 49,000.

My doctor wants to put me on ddi, d4t, and sustiva. Im confused on what to do.

If im still seroconverting wont my t-cell's go up and the viral load go down? Are these levels high for som,eone who just got infected ? We knoe that im sensyitive to all med's whcih is a good thing.

I've read so much on the pro's and con's on going on med's early-- can you give me and further information

Thanks

A tough circumstance to be in.

Here is the issue that we are dealing with. We know that after exposure, there is a burst of a very high viral load that comes steadily down over the first six months after exposure. Just what you report. And the T4 counts respond often just like you report as well. And after about six months, you would come to some stable "set point" which is the highest viral load that your HIV can create given what your immune system can do to control it. And for a few, the viral load can head to a very low number - low enough so that meds may not be needed. So - shouldn't you wait for six months to see where this will land?

Well, the other news makes us want to intervene. Early on after exposure, there are cells in the immune system that appear to be responsible for controlling HIV growth. But these same cells are often lost in significant numbers over the first six months. As a result, by waiting, you risk losing the very part of the immune system that could help your body control HIV itself. And some studies have been done to show us that when people intervene - these cells are preserved - in a way that helps this group look just like those few percent who are stable off antivirals years later.

So the gamble is no meds now to see if you you are in that more fortunate group, versus meds now to increase the chance that you will be in that group. So - it all comes down to - how good or bad are these meds anyway? If I start, am I trapped on them forever? What about resistance and all those side effects?

The combination you mention - d4T, ddI, and Sustiva - is now under active study. It is likely to work quite well - based on similar kinds of combinations already studied and shown to work. And one international study - comparing those three meds with a four drug combo adding hydroxyurea to this trio - is also hoping to answer the question of if there are ways to further improve on these generally successful combinations with hydroxyurea. (That study is open in about 7 sites in the US including Boston, Chicago, Texas, NY, and others, and in Paris, France.) Some information suggest that hydroxyurea might help the immune system control this virus that much better...

And how rough are these combinations? Well, since ddI has some info to show it works well when taken just once a day, and Sustiva is just once a day, then all you need do is take a d4T capsule in the morning with or without food, and then at bedtime, take the triple, which is about 6-7 pills in all (depending on which dose of ddI you do.) So - how hard is that? Or you could take the ddI in the morning instead, and have less to do at night. Options.

And keep in mind that you may not have to stay on these meds forever to keep HIV under control, especially if you start soon. Since the hope is that maintaining those cells in your body by treating now could allow your body at some point to do the job without meds.

But you must be ready to do meds if you do them. Since they only work their best when you take them all, each day, each dose. We have seen too many bad outcomes when the doctor was excited about meds, but the person taking them was less sure, or just had trouble remembering it all. Those persons have not only had less success, but developed resistance way too early in this multiyear process...

But also remember - if you are successfully on a combination and for whatever reason change your mind and need to stop -- that does NOT create resistance to the meds. While HIV could come back - if it comes back when you have stopped the meds - the HIV would very likely still be sensitive to all the meds. These meds don't need to feel like some endless tunnel that you are stuck in - you can still have a choice at each point that makes them safe to use.

Could you do it? How can you tell? Most have never taken meds twice a day every day so how could you know? There are some who would suggest some kind of med taking 'rehearsal' - with vitamins, or even jelly beans. Just to get some idea of what this could be like for you. But if you want to, you likely could - the combo you mention has some flexibility around it as I mentioned.

But no one can put together the pros and cons and weigh them for you - only you can do that part. So hopefully you can find someone who can help you sort through your own version of this - and come to your own decision.

Hope that helps. CC