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Another Q for DR. Wohl
Apr 26, 2003

Hi Dr Wohl --this is the same newly diadnosed guy with another question.

1. With tcells of 535 and vl of 328,000-I have a ratio of 18. Do you really think I can wait to start meds? (My doctor, who I have only seen twice, seems to think I should start soon though I do not want to).

2. You told me last time that my numbers were stable--does that mean there is little or no chance that this vl may go down w/o meds?

Thanks Kevin

Response from Dr. Wohl

Dear Kevin,

Your doctor I suspect is motivated to prescribe you HIV medications because your viral load is relatively high. However, our CD4 cell count is well above the level most clinicians use as a benchmark for therapy initiation (around 200-350). The published guidelines do indicate that both a low CD4 and/or a high viral load are indications for considering the start of HIV medications. However, most clinicians place greatest weight on the CD4 cell count.

Personally, I would not start you on HIV medications, despite your viral load, unless you had major symptoms of HIV disease (night sweats, weight loss, recurrent infections, etc).

Chances are, your CD4 cell count will drop in the near term. I say this because generally the higher the viral load, the quicker these cells tend to decline. Will it take a year for your counts to dip below 300? Two years? Three? No one knows, but I would watch your counts and react accordingly.

The stability of your CD4 and viral load off therapy has no bearing on what will happen to your counts after you start therapy. If anything, I think it is a good sign that your CD4 cell count has maintained as well as it did.

If you feel conflicted about starting meds, get a second (in person) opinion from another HIV experienced clinician in your town and if there is disagreement between your docs, consider me the tie-breaker.

Good luck - DW

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