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Am I being too concerned about my numbers?
Jul 31, 2004

First, I want to add my voice to the chorus of appreciation for all that you do. Being HIV+ would be a lot scarier and a lot lonelier without you folks.

My question is whether I am being too alarmed about my numbers. I contracted HIV in January 2003, seroconversion illness was extreme and protracted (lasting ~3 or 4 months). At present, my main symptoms are PN, lack of energy, and occasional diarrhea. I am a 47 yr. old male.

At the time of diagnosis, my VL was >500,000, and my CD4 was 200/16%. These subsequently improved through the summer, but my numbers seem to have been steadily worsening since the winter: Date VL CD4 CD4% 10/29/03 - 30,064 - 340 - 23% 12/19/03 - 40,000 - 350 - 22% 03/05/04 - 83,000 - 340 - 20% 05/28/04 - 80,520 - 330 - 20% 06/29/04 - NA - 310 - 19%

(I won't know 6/29 VL for at least another week. The 10/29 VL of 30,064 was the lowest since infection, and the 12/19 CD4 of 350 was the highest since infection.)

I know that it usually takes somewhat longer than 1.5 yr. after infection before starting meds, but I think my numbers are telling me that the virus isn't going to wait.

My "HIV-attuned" primary-care physician, who I like and trust, shares my concern, but my (highly-regarded, widely-respected) HIV specialist seems not to be concerned. I saw the specialist in April, and am not scheduled to see her again until October. I can likely accelerate that, but I don't want to do so if there's really nothing to worry about.

I have read "The Gudeline" along with a gazillion other references, and I can see how I can be considered "borderline", but I tend to think that the trend should be as important as the absolute numbers themselves.

Am I just being a worry wart, or is my specialist perhaps not seeing the overall trend? At a CD4 of 310/19%, I feel as if I don't have a lot of headroom left.

And once again, thank you so much for being here, and doing what you do.

JD

Response from Dr. Pierone

I share your concern and do think that the trend is very important. Based on the steady progression, it seems that you will need therapy sooner rather than later. Since you are having symptoms, why not start therapy now? It sounds like you have read quite a bit about treatment, and if you are ready to start I don't see great benefit to waiting longer.

I don't mean to say you can't wait; your numbers are in the "gray zone" and deferring therapy is not an unreasonable course. If you do decide to go on therapy, full adherence is crucial of course. Just as important is finding a regimen that works well without side effects. Antiretroviral therapy has for treatment-nave persons has greatly improved over the last several years with the approval of Viread, Reyataz, Emtriva, and Lexiva.

Good luck!



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