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time to start meds?
Jul 19, 2003

Tested pos March 2003 after a negative test one year before. March and April blood work showed tcells from 340-530, and vl from 350,000 to 535,000.

Latest test in July showed tcells 350, vload at 400,000. Doctor says I need to start meds now. He said with my vl my tcells will be at 200 in 6 months. But if that is the case, why have my tcells not lowered in past four months? I hear so many horror stories about meds, and I have a friend that has never neen on meds after 15 years of diagnosis. Some people in HIV chat rooms say not to get on the meds--they are worse than the alternative. I realize that is probably only true for slow progressors or nonprogressors. But still. I am a reasonable person--but I need help in deciding. I feel maybe I should check labs every four months and wait until tcells drop lower--like to 250 or 300. Isn't there a chance that they may not drop as fast as usual--? If there is that chance,however remote, what would be the benefit of going on meds now? Please help! Kevin

Response from Dr. Wohl

Dear Kevin (again)

In most cases HIV therapy is not an emergency. Statistically, your doctor is exactly right - your CD4 cell counts should drop rather fast. However, as you may have noticed, you are not a statistic but an individual with a unique immune system, virus and health status. No one can say for certain what will happen to your CD4 cell count.

Is there fantastic risk of harm by waiting a couple of months and checking again? I think not. I understand your apprehension regarding HIV therapy. Remember, few people write in to chats to tell everyone how they are tolerating their meds wonderfully, yet most do.

Therapy is important and when the time comes will help get your immune system back to where it belongs. Waiting until a clear trend emerges makes sense as long as it is done under the careful watch of your clinician. DW



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