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Starting meds with high CD4
Apr 9, 2004

Hello and thank you for the usefull informations on your site.

I'm a 34 year old man living in Poland. I may have access to modern HIV medicine. I was diagnosed in sept. 2003, and infected in february 2001 through heterosexual intercourse. I've been trying to inform my self since I have Internet for 2 monthes, but the informations I get are very contradictory and I'm confused. First, here are my labs result:

Sept: VL 17 000 CD4 640 %31 Dec VL 10 000 CD4 1230 %32 March VL 22 000 CD4 1170 %33

I know you are very busy but I have many questions. I have the feeling that my doctor is not well informed (he is a "normal doctor" at the hospital):

1) My doctor says I should start medications and take them during 1 year or so because i'm was infected only 2 years ago, to stop the viral load growing and to keep my CD4 count as they are before they fall. If I start meds what would be the best drugs for someone like me?

2) He said as well that such a high CD4 is not usual and that he is not sure if this is good or not.What could be the reason of this rise in CD4 in the last monthes since the % remains the same?

3) I habe no symptoms except 2 swollen lymph nodes on the back of my head. Should I worry about this?

4) If I don't take any medication how long do you think it would take for me to have problem with my health or to have less than 200 CD4?

5) My doctor says I have 13 - 15 years to live according to statistics. Is this accurate?

Thank you very much if you can respond.


Response from Dr. Wohl

Dear Tadeusz,

Your instincts are correct, your doctor does not know what he is doing.

You should not start HIV medications. Your CD4 cell count is high and there has been not demonstrated benefit to initiation of treatment at a CD4 cell count at your level. Need verification? Check out the U.S Public Helath Service Guideline at

Si,ilar treatment guidelines are available from the World Health Organization (WHO) and the Iternational AIDS Society (IAS).

Most clinicians do not consider starting HIV therapy until the CD4 cell count is 200-350.

Your high CD4 cell count is NOT unusual. You have a relatively low viral load. Therefore, your CD4 cell count declines at a slower rate than someone with a higher viral burden. This is good and means it is unlikely that your CD4 cell counts will drop to treatment requiring levels for several years.

The absolute CD4 cell count could flucuate for a number of reasons including lab error. Your CD4% is stable and your last 2 absolute CD4 cell counts were identical - I'd believe it.

You lymph nodes are probably just your bosy dealing with HIV. If they are not growing, I'd leave them alone. If they do grow a biopsy may be required.

Good luck


Desperately Seeking Undetectable

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