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When should I start?
Apr 26, 2004

Hello, I found out I was HIV positive in April 1992 and probably infected 3 months before that. Since then, my t-cells have slowly fallen and I'm still not on meds. My last 3 counts were (based on quarterly labs) 343,21%, viral load 1350. 324, 23%, viral load 480 and my current one was 312, 21%, viral load 1480. My viral load has never gone over 2000. So my questions are, when should I start Meds? Can I wait longer and based on my numbers how long can I wait?

Thanks so much, Grand Rapids

Response from Dr. Wohl

Dear Grand-

You are enjoying the benefits of having a low viral load set point, meaning your virus long ago settled at a pretty low level and while you are not a long term non-progressor, you are a darn slow one. With time, however, your low level virus level is whittling down your CD4 counts. If you graph out your CD4 cell count over the past 5 years and drew a line continuing the downward slope you can estimate when your count will drop to a level that might trigger you and your clinician to start therapy. For most that will be a level 200-350.

If you are living in Michigan, it is likely your doc will consider you close to the starting line now. If you live near the Grand Prix in Monaco, your doc may be inclined to wait until your counts fall closer to 200. Given your trend to date, that seems like quite a bit of time from now.

So, although you clearly qualify for therapy based on your counts there is no urgency and I would not fault you or your doc for waiting a few months to a year and seeing what happens. However, if your downward CD4 trend over the past few years has you down, or you are in anyway symptomatic from your HIV infection, starting treatment now can be attractive. DW



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