low VL and low CD4, start now?
Sep 19, 2003
I've been positive for the last 6-18 mos. Cd4 and VL have both always been low. Tested three times over last 6 mos. cd4 281/VL 3000, cd4 325/VL 1500, cd4 301/VL 17,000. I have a persistent but mild sore throat but shrink says may be side effect of Prozac, otherwise asymptomatic - but worried. Would rather not be on meds but have an opportunity to enter a study and get drugs for free (I have no insurance). The two arms of the study are; 1)tenofovir, emtricitabine, efavirenz all once daily, or 2)combivir and efavirenz. Three questions; Do you think I need to start now? Are these drug combos a "best choice" for treatment naive people with my numbers? And, a fellow HIVer said that often in the first year of infection a persons CD4 cell count often rebounds to a higher "set point" and then gradually declines over time. Is this true? And is there a reasonable hope that this may happen for me - meaning maybe I could wait to start meds. Thanks as always for your thoughtful and prompt response. The study may close soon and I need to decide ASAP.
Response from Dr. Young
I would recommend starting therapy with your current numbers (at least in the near future).
The fact that you have a study option shouldn't be the sole basis for starting immediately, but does influence the timing. Moreover, an often forgotten fact is that patients in clinical trials tend to have better results (probably because of greater attention to education and adherence) than those who are not on studies.
The study that you have access to is a very good one and either treatment arm will likely have excellent results- low pill counts, suberb potentcy and excellent tolerability. The real question is which one might perform better-- the only way to find out is to actually conduct the study.
Lastly the set point issue is really only relevant to persons who are acutely (very recently) infected. If your HIV antibody test was positive (not indeterminate), it is unlikely that your numbers reflect this situation; moreover if your current labs don't show dramatic changes in CD4, it's unlikely that you're acutely infected.
Good luck. Let us know how this turns out-- our readers would certainly be interested. BY
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