I am located in south africa in an area where I can not get frequent cd levels or any viral level tests. Fortunately, I can get medications through connections in the UK. I have been hiv+ for 6 years and started to develope night sweats, tongue whiteness (at the edge), chronic fatigue, slight loss of wieght. I figured starting on medications would be needed and can get viread/epivire/sustiva routinely from the UK. Any information on treatment without frequent test followup would be appreciated. Am I up a creek without a paddle??

Thanks for your question.

As a North American doctor, I probably will have difficulty answering with great insight, but here goes anyways.

The drug regimen that you'll start should be very potent and well tolerated. I'm not sure about whether the drug has been studied in the RSA, but seems reasonable to think that it should work, particulary if you have not acquired your virus in drug-resistant-prone parts of the world.

Monitoring HIV treatment without labs can be difficult (especially for those of us, like me, who are used to getting a lot of lab work to follow my patients). Some have advocated following your weight as a tool to monitor progress; a simple blood test- the complete blood count; or lymphocyte count - are widely available and this might be an alternative to getting the CD4 cell count and viral load.

Certainly, should you find yourself in a situation to get a HIV viral load or CD4 cell count in RSA or elsewhere, I'd advise this, irrespective of whether you're on therapy or not-- the information would be very useful.

No, your not up a creek without a paddle; you have both the canoe and a paddle; just no map to tell you accurately where your at.

Stay in touch, good luck and have a bite of biltong for me. -BY