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Really need your help now!
Sep 27, 2003

Dr. Young, Ok, I hope this isn't approaching harrassment. I keep coming to you with more and more questions...which is starting to make me think I need a different Dr. I hope you remember me. I tested positive on my first HIV test back in July of this year. I have had my blood counts taken once every 2 weeks for the past 6 months. So now I have 3 sets of Lab results. They are as follows:

CD4 counts: 1237 (yes 1237), 347, and 332

VL: 56,000, 27,000 and 16,000

Percentages: 52, 16, 16

Now this has all taken place over the course of 6 weeks. My Dr. wants to start me on meds and is currently testing my blood for genotype and what he called virtual phenotype (not sure what that is). I want to avoid meds if possible, but will adhere if really need to start...which he said it's probably time to start. I had a possible exposure 2 weeks prior to testing positive. Married...wife is negative. Wow this email is going all over the place...let me get back on track.

I read that when you are first infected, your counts go all over the place. They spike up and drop very quickly. I can't pinpoint if I was infected recently or years ago. But should I go on meds or should I wait and get a second opinion from another Dr? I'm very worried. Not sure if you need this, but 5'11" 198 lbs, strong, athletic build. Work out 5 times a week and play basketball throughout the week.

Thank you as always,

EW

Response from Dr. Young

Sorry to hear about your situation.

It's difficult for me to explain the large variation in your labs-- it's possible that you had acute infection early on, but also possible that the first set represent a lab error.

Either way though, with a reproducible CD4% around 15%, it's time to start on treatment. Your doctor is doing a wise thing in testing your virus to be sure that the medications that you ultimately go on to are going to be fully active. (The "virtual" part is a prediction of the true activity profile of the drugs, based on reading the genes of the virus -- a "genotype".)

I can appreciate wanting to avoid medications, is possible, but with this level of CD4 cell, you are at increasing risk of having an AIDS-related complication-- some of these complications can be very serious, or even life threatening. Contrast this to the situation of easier and easier to take medications with few or no side effects.

You're always welcome to get a second opinion (though I sense that this may be a second anyways), but other than repeating the lab tests again; nearly all US-based HIV specialists are likely to recommend starting in the near future.

Good luck, BY


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