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CD4 196/VL 30,000: Should start treatment?
Jan 8, 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. Pierone

Most doctors would use 200-350 (in the United States) as a window to start antiretroviral therapy. Virtually all would start at a CD4 count below 200. Your girlfriend's doctor probably wants another reading with the belief that it may be above 200 and allow treatment to be deferred. There is no risk in waiting another 3 weeks.

We talk about shared decision making model in medicine now with the patient (with input from significant others, of course) making joint decisions on treatment with the doctor. The older paternalistic model of "just do what I say and follow orders" is a goner (deservedly so). So if your girlfriend is uncomfortable being off therapy around this 200 level she can question her doctor about it. It is ok to be assertive if things don't sound right. Good luck!



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