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Confused about when to start meds
May 30, 2004

I tested positve for HIV about 2 weeks ago. I got my first lab results a couple of days ago. My CD4 count is good - 601; however my viral load is really high at > 100,000. My doctor suggests that I consider starting treatment to bring my VL down. The fed guidelines I have read place me in that "limbo" cateory. Basically, they say treatment should be considered but it is not definitive. That doesn't help me much with my decision as to whether or not to start treatment. Should I consider waiting and see what my CD4 count does or will I be running a big risk that my VL can continue to rise? What are your suggestions? Any articles/studies you can refer to me? Thanks.

Response from Dr. Young

Thanks for your questions.

In general, if your feeling well, I use the CD4 count as the primary component in deciding when to start. With a CD4 count of 600 (provided that this is confirmed with your next tests), you don't have an immediate need to start on meds. Your viral load is high, meaning that for you, it is really important to make sure that you get periodic (at least every 3-4 month) testing to make sure that your CD4s don't drop precipitously. I don't think that "bringing the viral load down" as the major goal of therapy, but rather that increase in CD4s-- of course, the necessary way to do this is by effective, potent treatment that lowers viral load.

The most informative studies on this are the MACS cohort and EUROSIDA studies-- these give some glimpse of the risk of AIDS progression on the basis of CD4 count and viral load.

Hope this is helpful. BY

Tenofovir, nevirapine and lamivudine

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