Dr. Young, You wrote in an earlier response to someone that, if their CD4 count was above 250 and VL below 55,000, they should stay off HAART - unless they are "symptomatic."

What symptoms warrant going on HAART? For example, if someone is not wasting/losing weight and does not have temperatures, nausea, fevers or night sweats....but has bad symptoms such as chronic pharyngitis, diarrhea and lymphadenopathy (sore, but not swollen nodes), should they go on HAART, considering that HAART can cause symptoms of its own?

In other words, what symptoms will cause you to ignore higher CD4 counts and low or undetectable VL's and what symptoms will cause you to advise a patient that they should deal with them and delay HAART till CD4 is lower or VL is higher?

Also, do you believe, if a VL is undetectable, that symptoms cannot be caused by HIV as some doctors do (viz. undetectable VL test means symptoms are not due to HIV) or are you of the school that bad symptoms can still be caused by HIV even if a VL is undetectable? Have you ever put someone on HAART who had bad symptoms (sore lymph nodes, malaise,some nausea, daily diarrhea, sore throat etc.), but was not wasting, had no fevers, had a CD4 count above 500 and an undetectable VL by Roche 1.5?

Many thanks.

The symptoms that you've listed (pharyngitis, diarrhea,etc)wouldn't necessarily prompt me to start HIV therapy, though still deserve medical attention and evaluation.

By contrast, the first set of symptoms, weight loss, wasting, night sweats, or any AIDS-defining illness-- irrespective of CD4 would be an indication for therapy. BY