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Benefit from Beginning HAART with CD4's 300-350?
Jan 2, 2003

I estimate I contracted HIV in February or March of this past year. In September doctors at a local clinical trials unit performed a detuned assay and informed me I was "chronically infected" (more than 6 months?) My CD4 counts at the time were only 328, with a viral load of 41,000. The same research physicians recommended I begin HAART. My personal physician did not offer or recommend I start the meds yet. Here, three months later, my CD4 counts are 319, with a reduced viral load of 1,293.

My BIG question: Is there enough evidence to warrant beginning HAART in the 300-350 CD4 count range for any hoped-for preservation of the immune system? Could my immune system be benefitting from taking meds now?

Thanks for your help,

Kaeb

Response from Dr. Wohl

Dear Kaeb,

There is currently some debate about at what exact CD4 cell count is therapy best started. The data are pretty clear that if you start at a count below 200 your chance of having something bad happen is higher. The data get a bit murkier when we are talking about counts between 200 and 350. Part of the problem is that the studies we are being guided by were designed to answer other questions and are limited by relatively short term follow-up.

For many starting at counts around 300 or so provides a bit of a comfort zone before the 200 line in the sand. And, some (but not all) studies do show benefit when HIV therapy starts at counts in this range. For others, delaying therapy until the last minute seems most attractive.

If you have signs or symptoms of HIV infection (fevers, night sweats, loss of 10% or more of ideal body weight, thrush, etc) therapy may be warranted. I'd also check that viral load again. A drop form 41,000 to 1,200 is a bit odd. This is important because the lower your viral load the slower your CD4 cell counts will drop. When in doubt, wait, check the numbers and see. DW



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