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CD4 231 VL: 1000 Cocktail now or later?
Feb 8, 2004

First off, thanks for this forum and your help--a Godsend. Asking for my good friend. The VL is 1000 only and CD4 hovering between 220 to 233. The doctor recently commented that 233 is not much different from 199 and perhaps cocktail should be considered. Aside from fatigue, almost not much symptoms at all. My friend is not sure when he was infected (if that plays a factor at all). He wants to delay the cocktail treatment due to the side effect affecting his work possibly, among the obvious psychological reasons.

My question is: 1. Is the CD4 count the be-all and end-all factor for Cocktail or not, especially with his VL so low? 2. My friend is in his early 30's. Will it be sensible even to ask what will the life expectancy for anyone entering cocktail? It is an important question for him to prioritize things in lfie.

Thanks, friend of poz

Response from Dr. Young

Thanks for your post and kind words.

I agree with your friends doctor. A CD4 count around 200 is a very strong reason to start therapy for HIV. While no single lab test should be used as the sole basis for the decision to start therapy or not, a count at 200 means that the risk of having an AIDS event (like serious, life-threatening infections or cancers) is sufficiently high that to me, the benefits of antiretroviral therapy far outwiegh the risks of side effects.

HIV can cause immune cell depletion (CD4 cell drop), even if the viral load is low (like your friends). The viral load simply predicts the rate of future CD4 decline, but not of the immediate risk of complications.

Second, sure, it's reasonable to ask about life expectancy. With well designed and well taken "cocktails", I tell my patients that they should expect normal or near-normal life expectancy. This doesn't mean that there might not be some issues with side effects, or even treatment failure; but rather, that with contemporary treatments, we're able to restore immune health to the vast majority of persons who have access to care.

Thanks again, friend of poz. BY



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