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Re-start Meds?

Aug 2, 2003

First of all, THANK YOU for all your work and expertise. Infected with HIV a year and a half ago. At diagnosis, some 5 months after infection, counts were VL 300K, CD4 600 (34). Doc started me on a 6-month course of Sustiva, Viread, Epivir, said there was value in combatting an early infection. Mid-treatment showed VL<50, CD4 at 600(34), then one month after treatment suspension it was VL 17K, CD4 750 (39). Now, 3 months after treatment my values are VL 85K, CD4 545 (33). He says I might want to go back on. I am wondering that we are not seeing enough of a trend, and should possibly re-test in another 2-3 months. And I wonder about the damage to my body from taking this combo unless it is absolutely necessary? What do you think? I am 50 yr old, otherwise healthy man. THANK YOU! Stephen

Response from Dr. Young

Thanks for your question.

I don't think that anyone has a concrete answer to your question, unfortunately. I do agree with you that trends in labs tests are very, very important in trying to decide about the direction of HIV disease; as such any single lab test should not be used to make this decision.

We really don't know about the "damage" that is incurred by stopping after initial treatment, furthermore, the amount of immune "benefit" that you get after starting therapy early, probably (but not certainly) depends on how soon after the intial infection you start.

One pragmatic way to balance these two points of view would be to repeat a CD4 count and viral load sooner that you might otherwise have-- say after 4-6 weeks.

With these two sets of information, you might get a better, and earlier sense of which way to go. Sorry that I couldn't have a more solid recommendation. Good luck. BY

your advice
False negative on VL tests?

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