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Senior citizen and HIV
Jul 2, 2003

Hi

I just found out about this page and I think it's great we have the opportunity to ask questions to real doctors. I write because my mom(who is 65 years old) was diagnosed with HIV in May 2003. She got it due to a blood transfusion in December 2001. Needles to say we are all devastated and still can not believe she has it. Back in May 2003 she had the following numbers: CD4 278, Viral Load 12000.

She went to 2 doctors..one of them told her not to start any treatment and monitor her labs quarterly .The other doctor recommends to start treatment. He mentioned that the size of her spleen is bigger than normal. Of course, we are all confused. Sometimes she is very,very tired but they also found that she has mononucleosis. My question is..with these numbers ..what should we do? What is you recommendation in this case with these specific numbers? and why?

Response from Dr. Young

Thank you for your question and sorry to hear about your mother.

There isn't a absolutely uniform consensus about when to start HIV medications. Current recommendations suggest starting therapy in asymptomatic persons with CD4 counts less than 350 or with viral loads greater than 55,000 copies. Nevertheless, it is important to bear in mind several features about women and, hmmm, older patients with HIV infection. First, it is clear that women tend to have more rapid HIV disease progression than men with the same viral load; additionally, for older persons, the amount of CD4 cell rise tends to be less than younger persons.

Based on this, and a general philosophy that says, when in doubt, treat; I'd be recommending considering treatment.

This is not to say that this is an emergent decision (it rarely is), nor does therapy have to be a complicated, side-effect prone experience.

I'd work closely with your mother's physician to discuss the pros and cons of different strategies for therapy, continue to get close clinical and laboratory monitoring.

Good luck. BY



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