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If treatment is MY decision,why am I told NO?
Apr 11, 2004

Hello, I'm a 31 yr old HIV+ female, Diagnosed 11/27/02. I know and understand that the debate on when to start treatment is varied in the medical community. Some say "Fast & Furious", some say, "Wait & See" I was told that the option to start treatment was ultimately MY decision, so why did my doctor tell me NO when I asked to be started on a Regimen? My CD4's are 803, and my Viral Load is 1580, I know my numbers are in VERY good shape, but why do I have to wait for them to deminish and lose what I have before someone decides to take notice, and allow me to start treatment? It just doesn't seem right to me.

Response from Dr. Young

Thanks for your question.

You raise a central issue for the treatment of HIV-- namely when to start.

Most experts agree upon waiting to start therapy until patients are either symptomatic or are asymptomatic with CD4 counts that are below ~350 cells. The philosphy of waiting isn't based on the principle of loosing immune function, but rather a balance between the potential for benefit and the potential for toxicity. This later issue of toxicity has gained much attention, as earlier treatments were very side effect prone and when not prescribed or taken well, left patients with the very real (and irreversible) toxicity of drug resistance. This coupled to concerns about long-term toxicity and observation that functional immune reconstitution can occur in persons with very low CD4 counts has led to the wait and watch approach that your doctor has suggested.

You currently have a very high CD4 count and a very low viral load-- suggesting that you might be able to defer on initiating therapies for many years-- the very years in which we will undoubtedly see significant improvments in our treatment options.

In the end, I'd suggest having a lengthy discussion about your specific situation with your doctor or local AIDS counsellor.

Good luck and thanks for reading. BY



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