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South African Treatment
Jun 2, 2004


my country has finally started with ARV's, which is wonderful! However, you are only allowed to get treatment when your CD4 count is below 200. I have been reading other answers on your website about when to start treatment- and it seems that your policy is a CD4 count below 350.

I am confused, when is it best to start treatment? and are the drugs less effective as your CD4 count decreases?


Response from Dr. Young

Thank you for your question.

Congratulations to your country for starting wide-spread distribution of HIV medications.

There is quite a lot of debate about the optimal time to start medications. Here in the US (where we tend to have better funding for medications), we typically start therapy with CD4 cells below 350. Other well endowed places, like the EU or Canada tend to wait until counts are around 200. It is very clear in both cases, that starting therapy when counts reach 200 is very important, and will save lives.

The debate is about the patients with counts between 200 and 350-- here it is more difficult to measure benefit in lives saved, since most life-threatening events happen when counts are lower. There is a sentiment that certain complications (such as neuropathy or lipodystrophy) may be more likely to occur if one waits to initiate therapy, and in part is the basis for the earlier initiation of therapy here in the States.

Current therapies have been shown to be similarly effective in persons with higher- or lower CD4 cell counts, as well as in persons with higher viral loads.

No matter what, getting medications to the people of South Africa will save countless hundreds of thousands of lives and prevent thousands of children born with HIV. Congratulations to all, I hope for a better day for the health of your contrymen (and women and children). BY

2004 dead for hiv drug approval/Norvir price hike

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