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Time to Start Treatment?
Sep 11, 2004

I had my 3 month appointment with my HIV doctor today. I was diagnosed 7/12/2002 (just after my 22nd birthday, though I know my infection date to be 4/18/2002 for certain), and have thus far avoided treatment. My CD4 % has slowly dropped from 27 to 23%, and has been hovering between 20 and 22% for the last year and a half now. My Viral load has been all over the map from as high as287,000 to as "little as" 29,500, with absolutely no consistency between visits. My CD4 has been up and down, and for the second in a row, has been down, from 399 to 320. So, I've hit below the magic "350" threshold, and I'm now considering treatment options. The doc seems to think that since my CD4 percentage is still at 20% and my total lymphocyte was only 1600, it may not be so unusual that my CD4 absolute count would have gone down. However, I'm not so convinced. I've requested another set of labs, which I will go in for on Saturday, and if my CD4 absolute is still below 350, I want to start treatment. My question is two parts: as a doctor, would you also recommend more labs showing results below 350, and go more by the CD4%, would you have started treatment earlier, or recommend it now? Also, if I start treatment next month, what therapy would you recommend. My doctor mentioned a new combo pill of a two drug, once daily treatment, that could be taken in conjunction with Sustiva, for a 2 pill, once a day treatment. I want something powerful, yet manageable, as I fully understand the importance of adherance.

At 24yo, and postive for two years, I am hoping my numbers to rebound quickly (hopefully a CD4% up to 35-40% with CD4 absolute between 640-1100, since I started with 792.)

Sincerly, Painfully Pondering in Michigan...

Response from Dr. Pierone

There is no compelling reason to start therapy earlier than 350 CD4 based on a lower CD4 percentage. The evidence that informs the formal recommendations to start therapy below 350 CD4 cells is not robust, but better outcomes are seen in this CD4 range and it is reasonable to start below this threshold.

Your doctor is referring to Truvada, a once-daily combination of Viread and Emtriva. This may be used together with Sustiva to produce a simple, potent, and well tolerated regimen. This appears to be one of the best regimens currently available. Thanks for posting and best of luck.



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