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how sick do i need to be to begin?
Sep 9, 2003

Hi

I was diagnosed in April this year. At disgnosis my CD4 count was 390 but since has dropped as low as 280 and is now back up to 330 (but with the same percentage as when it was 290). My viral load has increased a little from 31,000 when diagnised to about 35,000 at the present moment.

I have been relatively unsymptomatic...some fatigue, some recurrent urine and bladder infections...but nothing unmanageable.. My doctor recommends no treatment at present....and while i've agreed with this until now....I kind of feel I have some kind of perverse incentive to get sicker....so that i can access treatment....any words of wisdom....?

Response from Dr. Young

Thanks for your question.

I think that it is important to recognize that the best time to start is, at best, controversial. There are guidelines that suggest starting if your CD4 count is below 350 (repeatedly); but as you point out, sometimes there can be a sense of waiting for things to get worse before starting. Indeed, the only thing that will happen by waiting is a further loss of CD4 cells and increased risk of having a complication.

As such, for persons like you who have a relatively low CD4, but are asymptomatic, I think that there is enough controversy that if my patient were to want to start on therapy and was able to be adherent to treatment, starting meds now would not be a bad thing.

I'd certainly advise you to speak to your doctor about the risks and benefits of waiting and the risks and benefits of starting therapy. Good luck. BY



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