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Aug 5, 2003

Dear Drs, My CD4 are currently 682, stable since 1 month after infection, VL undetectable 8 months out from infection(now). Feeling very well. Should I just monitor my CD4, VL levels and start treatment when I fall below 350, above 100,000 or otherwise get sick? How long can I expect to be in the current "phoney war" phase, and how long could I realistically expect to be sustained by meds once the virus causes one of the above scenarios? Regards

Response from Dr. Young

Would seem to me that you're past the time when treatment during the acute phase of infection would be possible.

As such, you fall into the usual category of persons with established, chronic HIV infection. For these persons, we generally recommend waiting to start until the CD4 cells have dropped to just below the "normal" range-- that is, less than 350 cells. Persons with high viral loads or who are symptomatic would also be considered for initiation of treatment, irrespective of their CD4 count.

As for how long, this really depends on viral load-- if your viral load is truly undetectable, then you are one of the very lucky ones who would appear to have good immune control of the virus, and there is a reasonable chance that you won't have significant CD4 cell decline any time soon (or to put it another way, you might be one of those long-term non-progressors). Bear in mind that the average viral load, is about 50,000-- persons with viral loads at this level can expect to reach AIDS levels (less than 200 cells) after about 8 years of infection. Given your viral load, I would definitely wait to initiate treatment, since it could be many years, well more than the average 8-10 years before you'd need to start, if ever.

With current therapies, I would also expect that should you ultimately need to start, that the medications would "sustain" you (improve your immune function and health) for many additional decades.

Good luck. BY

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