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May 30, 2004

My nephew, living in London England, had tested HIV+ just about 2 yrs ago. It was found rather quickly as he was vigilant about being tested. Just this past week he was told his T-cell count was now down to 134, indicating he now has full blown AIDS. Help! He was never put on any medications (cocktails) after his initial dx. From what he told us, that was because he was not that ill and they did not want to start him on such a stringent regemin so early. Well now here he is with full blown AIDS. My question is this: Do you know why they would not have started him on any medications as soon as he was DX? Now that he does have AIDS, will they most likely be starting drug therapy? I am a bit lost with all of this. Everything I read says the usual progression is 7 to 10 years before HIV turns to AIDS. I am so afraid that this fast progression is leading to an early death. Your answer would be greatly appreciated.

Response from Dr. Young

Thank you for your question.

I can't speak to what the doctors were thinking in the past, though I can comment that there are clearly differences between the way that UK and US doctors approach the decision to start medications. The former tend to wait (in asymptomatic patients) until CD4 counts are below 200 and the later (me included) tend to start when CD4s are below 350.

There are a number of treatments that can be used, typically 2 nucleoside drugs with either a non-nucleoside drug or a protease inhibitor (the later typically boosted, in the US).

Certainly, without treatment, his health is in jeopardy, but on any one of a number of effective, well-tolerated regimens, your nephew should have an excellent prognosis. The most essential thing is that he be in the hands of an experienced HIV doctor and does everything possible to miss as few doses of his medications as possible.

I hope this helps, BY

2 mos. after seroconversion
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