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The Grey Zone 200-350 T-cells
May 29, 2003

Hi,

I was diagnosed HIV positive a year ago. My T-cell count has ranged from 285 to 400. Right now, it is about 316 or 25. My viral load has ranged anywhere from 40,000 to 300,000. Right now it is about 185,000. Both t-cell and viral load counts bounce up and down...there has not been a steady progression up or down in either case. I have been very healthy and have not had to deal with the side effects of meds. I read a recent article about the benefits of treating early. Is there any new evidence that says that I should start therapy early? I have had irritable bowel syndrome for most of my adult life and I'm very concerned about HIV meds making it even worse. I am also very concerned about facial wasting and lipodystrophy. If I were to start meds, is there a certain combination that you would recommend that is least likely to have the side effects mentioned above?

Also, I am moving to Philadelphia and would like to find a well respected HIV doctor. Any recommendations? I really appreciate your advice.....thank you, Jim

Response from Dr. Wohl

You are exactly right when you say your CD4 cell count is in the 'gray zone'.

The dominant paradigm in the US right now is to start therapy at a CD4 cell count below 350 if a patient seems ready, willing and able to take HIV medications.

Certainly, your moderate to high viral load suggests that you are headed toward further CD4 cell count declines in the not too distant future. When CD4 cell counts remain stable at 300-350, it is hard to get excited about rushing into HIV treatment if a person has no major symptoms of HIV disease and is ambivalent about therapy. One approach might be to follow your counts and if you have a couple of CD4 cell counts below 300, strongly consider starting treatment.

Philly boasts a number of very fine providers of HIV care. The University of Pennsylvania is top notch and they have an active AIDS research unit conducting clinical trials of initial HIV therapy that you may be very interested in considering (even now).

Thomas Jefferson Medical Center in Center City is another hospital with HIV experts on staff. Good luck - DW



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