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when to start drugs
Mar 3, 2004

I was diagnosed in 1982-3 and so far have not been ill. my viral load is undetectable and my cd4 count is around 250 which is pretty much unchanged since diagnosis. The doc {Dr Brettle Edinburgh Royal, Edinburgh, Scotland} has given me more info than i know what to do with and has left the decision of when to start drugs up to me! However Im finding this decision very hard. Any help would be gratefully recieved.

Response from Dr. Young

Thank you for your question.

I think that the key issue with the decision to start therapy for you (given your very low viral load) is that your CD4 cell count has not changed since your diagnosis years ago.

One thing that I'd check into is any trends in your CD4 percentage-- it probably also hasn't changed much, but it would be a good piece of corroborating evidence that little has change with your immune state. I'd like to see that your CD4% is above 15% (the level that typically correlates with a CD4 absolute, or total, count at 200.

While current US-based guidelines discuss considering starting therapy with CD4s below 350, UK-based guidelines differ somewhat in recommending therapy for CD4s below 200. We do know that the risk of having a complication goes up with CD4s below 200, and there is some risk with CD4s between 200 and 350, but the later statement is based on the whole population of persons with HIV.

I'd guess that continuing to wait in your circumstances would probably be ok- Make sure that you continue to get periodic laboratory and clinical assessments.

Good luck and thanks for reading. BY



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