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Four years since infection: time to start treatment?
May 23, 2004

Hello Doctors.

Thanks for the splendid service you provide here.

I have been spurred into considering treatment by being told this morning by a local general practitioner that I have shingles. It appeared four days ago. I've just taken the first of seven days' worth of Famvir.

I was infected with HIV exactly four years ago, in April 2000, at the age of 45. I am now 49.

My test history is as follows: 2000 Dec, CD4:318, Load:31,000 2001 Feb, CD4:258, Load:36,366 2001 Mar, CD4:365, Load:no test 2001 Jul, CD4:316, Load:19,000 2001 Sep, CD4:328, Load:29,000 2002 Jan, CD4:391, Load:26,990 2002 Apr, CD4:298, Load:18,000 2002 Jun, CD4:283, Load:no test 2002 Aug, CD4:317, Load:23,000 2002 Oct, CD4:233, Load:13,066 2003 Feb, CD4:257, Load:no test 2003 Apr, CD4:281, Load:26,000 2003 Aug, CD4:282, Load:9,831 2003 Nov, CD4:258, Load:13,185

Over the last four years I have had a number of sore throats, now and again. Over the last two months I have had constant white pin-head spots on my face, plus a general reddening of the face. This is I diagnosed as pustular psorasis and have treated it successfully with coal tar lotion. The only other problem has been several toenails going yellow and brittle.

The shingles that I now have has been the most noticeable and dramatic medical problem I have had since becoming infected.

When do YOU think I should start treatment?

Thank-you very much.

Response from Dr. Pierone

It sounds like you have done very well over the last 4 years off treatment, but the development to pustular psoriasis and recent shingles has you concerned (me too). Arguing against treatment is your relatively low viral load. Arguing for treatment is the CD4 count in the 200-350 range (the so called "treatment initiation range") and recent development of symptoms that are probably HIV related.

I think that you should start treatment now unless: 1. You are not ready to start treatment from a psychological, social, and financial perspective. 2. You don't think that you can be take daily HIV medications on a regular schedule and not miss doses.

Let us know what you decide to do and best of luck!

drastic change in VL
Stopped treatment after 4 days during acute infection

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