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Should I start treatment now ?
Aug 27, 2003

Hi, I'm a female living in South Africa. I tested positive this year January. My first test results were CD4 335 and VL 162 000, my next results were CD4 477 and VL 149 000, last results were CD4 571 and VL 182 000.

Please let me know when to start treatment and which treatment is best for me in order to reach the undetactable level,and I'm not sure which medications are available in SA. I've got no symptoms and have not been ill even with a flu , I'm just healthy. And lastly I still want to have a child as I'm still so young. Please help and sorry for such a long question.

Response from Dr. Young

Thanks for your note-- it's rewarding to know that our site has international readers.

With your CD4 count reproducibly above 350 and the absence of symptoms, if you were here in Colorado, we'd probably advocate not starting on therapy yet. Your viral load is pretty high and means that getting periodic (every 3-4 months) testing would be important.

I do understand that the Mbeki government has begun to make HIV medications available finally-- a glint of hope for your treatment options. Hopefully access to care and medication options will improve in the months to come.

As for pregnancy, this variable would change our general recommendations about starting therapy-- in your case, getting on a potent 3 drug regimen will certainly reduce your risk of transmission of HIV to your child, and as such if you were planning to have a child, I'd want to see you on treatment, at least for the later part of the pregnancy. Achieving an undetectable viral load and avoidance of breast feeding would be the best way to prevent transmission of HIV to your baby.

Which drugs to use? There are many opinions about this, but in the US (admittedly a very different environment than RSA), we'd be talking about a two nucleoside (usually Combivir or tenofovir/lamivudine) with a non-nucleoside (typically efavirenz-- but not if your thinking about pregnancy or nevirapine) or a boosted proteast inhibitor (like lopinavir/ritonavir).

Good luck and good health-- stay in touch. BY

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