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CD4 196/VL 30,000: Should start treatment?
Jan 6, 2004

My girlfriend got infected about a year ago. Her CD4 count started at 350 and decreased to 196 in her last test, 3 weeks ago. VL has decreased steadily, from 70,000 to 30,000. Her doctor wants her to improve her diet now to check if this could boost her CD4 count, although he's pretty sure it's the virus doing (het total lymphocyte count is in the 600-700s. She will take another test in two weeks and, depending on the result, he will advise her to start treatment. My question is: should she even wait that longer? Shouldn't her start the treatment now? Could these extra weeks worsen her condition? Thanks for your attention.

Response from Dr. Wohl

I don't think a 2 week delay is very risky and repeating the CD4 cell count makes sense prior to starting therapy. In the US, most clinicians initiate HIV therapy when the CD4 cell count falls below 350. In many other parts of the world physicians wait until the counts decline to 200.

Also, please note that there is variablity in the viral load and 70,000 and 30,000 are essentially no different when test to test variations on the same sample can be as high as 3 fold. DW



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