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When to finish early treatment
Jun 1, 2003

I have been on HIV treatment (Kaletra and Combivir)since I was diagnosed March 2002. As we believed I was infected shortly before, the doctors thought starting early treatment would be a good way of getting a head start, and reaching a low set point of the virus. At the time I was told I may need to be on meds for 9 months to a year. My levels went from T cells of 360 at diagnosis, 560 at 6 months, 570 at 9 months, and are currently 1011 (12 months). My viral load was undetectable from 1 month after beginning treatment. The doctors are happy with my progress however they have advised me to stay on them as my CD4:CD8 ratio is not yet right. I want to know the relevance of this ratio to stopping treatment and what this actual figure is. Does this point indicate a level of stability / control of the virus, when I can stop taking meds? If the ratios don't improve does this mean that taking the meds all this time was in vain?

Response from Dr. Young

Thanks for your question.

Unfortunately, I won't be able to give you a concrete answer as to when to stop. I do like the idea of using a completely normal T-cell panel as one measure of when to stop, though.

The CD4/CD8 ration looks at the proportion of "helper" to "suppressor" T cells in your blood. Normally, this ration is about 1-- in persons with untreated HIV infection, the ratio is usually a great deal less than 1, indicating that there is generally more immunosuppression.

I usually think that taking medications is not for no reason-- you've clearly had improvement in your CD4 cell numbers, and I'd suspect that other immune parameters have improved too. It would be tempting to speculate that your viral load after stopping might be lower too, but this might either be premature to predict or even a tad optimisitic.

I wish you good luck. BY



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