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Recently tested Positive - Need Answers
Sep 6, 2004

Hello, I have a two part question - First, I was recently diagnosed as being HIV+ and my currant levels are T-cells 399, Lymph Percentage 19%, Viral Load 100,000. Do you suggest that I should start treatment now and, can you suugest a certain drug regiman?

Secondly - Do drug resistant strains of HIV only get transmitted by individuals who are currently on HIV meds and pass the virus on?

Thanks for answering my questions!!!

Response from Dr. Young

Thanks for your questions. Sorry to hear about your recent diagnosis.

There is quite a bit of debate as to the optimal time to start therapy. If we assume that you're currently asymptomatic, then current recommendations focus starting therapy in patients whose CD4 counts are below 350. Your high viral load meets some criteria for starting, especially if your CD4 count is about 350 or less. As such, you're probably nearing the time when treatment would be recommended.

If you were my patient and were (appropriately) reluctant to start on treatment immediately, waiting a couple of months for a repeat set of labs wouldn't be unreasonable. This takes into account the large variability of CD4s and permits some time for you and your doctor to discuss your various options. I'd certainly recommend getting baseline resistance testing (as suggested by your 2nd question) as well as getting your vaccinations and other preventive medicine issues taken care of.

As for which regimens to use-- there are a number of treatments that are recommended. All are three (or four) drug regimens that use dual nucleoside backbones. A major decision is whether to use a non-nuke (like Sustiva or Viramune) or a boosted protease inhibitor (such as Kaletra or boosted fosamprenavir). For former have very low pill counts, the later have slightly increased pill number, but attractive resistance aspects. Boosted PIs are important for the unfortunate persons who might have acquired non-nuke resistance (the most common type of transmitted resistance). Nuke backbones have made progress in recent years, including two new combo pills that can be taken once a day (Truvada and Epzicom). Much of the decision on what to use hinges on whether you've acquired resistance or not (hence the importance of considering this before starting). My patients have had a resurgent interest in using boosted PIs first because of the possibility of preserving future treatment options in the event of treatment failure and the newer once daily options with low pill count. In any event, I can't tell you from the web what your best option is-- this is something for you and your doctor to discuss privately.

As to your second question, most drug resistant virus is likely passed on by persons currently taking HIV medications. However, this does not mean that persons not currently on meds (who have resistance) cannot pass on their resistant strains.

I hope this helps. Thanks for reading. BY



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