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Helping Friend Make Decision
Sep 13, 2004

My best friend went with me to get tested for HIV earlier this year. I was so scared about taking the test that he decided to get tested with me to lend his support. Indeed, I tested positive. We were both very surprised that he tested positive as well since he felt he had been very safe since his last test 2 years ago. More surprisingly my first set of labs were very good with a high CD4 count (610) and low viral load (200). His were not as good. His CD4 count is 351, VL 22,000 and the assay percentage is 20%. He is awaiting the results of his second set of tests (3 months apart). He really does not want to have to start treatment and is somewhat cynical about his lab numbers, treatment, etc. I'm encouraging him to consider starting treatment. I am recommending that perhaps he wait until his 3rd set of test in another 3 months suggesting that based on 3 sequential test results over the course of 6 months would be more indicative of a trend. Is there any danger in waiting much longer for this? Is there any other strategy or alternative that I could suggest to him in order for him to lend more credibility to his lab results. Fortunatley, he is taking excellent care of himself by eating right, getting good rest, etc.

He is also concerned that as he approaches the low 300's range in his CD4's, he feels that he is approaching a "final stage". I keep telling him and showing him info suggesting that with treatment his prognosis would be very different. Would you be able to provide some examples of people who started treatment in this range (300's) and their potential outlook (insofar as longevity, etc.) What are some the averages for people who start treatment at this stage and their progression to AIDS?

Thanks for the wonderful service you are providing to those of us living with HIV. I wish you contineud succes with your work and good health as well.

Response from Dr. Pierone

It does not sound like he is at risk for waiting to start therapy and getting several results to develop a trend is the way to go. The general guidelines are to begin when the CD4 count drops below 350 cells. This CD4 level is by no means the final stage, but rather the stage at which we suggest starting treatment.

The outlook for persons with HIV infection that have access to treatment is very good and we anticipate normal or near-normal longevity. The average CD4 count increase at the end of one year of therapy is about 100 to 150 CD4 cells and then about 30 to 50 CD4 cells per year after that. So we almost never see progression to AIDS in persons on therapy unless something goes wrong. What can go wrong? One of the greatest challenges in treatment of HIV infection is the need for high level adherence to prevent development of resistant virus. So anyone contemplating antiretroviral therapy must really be psychologically prepared to maintain high level adherence. If not, the long-term consequences of developing drug resistant virus could undermine any potential benefit.



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