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starting meds or not
Sep 13, 2004

Dear all, first a sincere thank you to all you volunteers who so generously donate your time and expertise to provide all of us with insight and answers, its helped me a lot over the last couple of years.

I tested positive in December 2000 and slowly but surely, my numbers are getting into the start treatment zone, so my doctor says. Back in 2000, my first labs, I had a cd4 count of 450 and a VL of 10.000. These numbers have gone up and down, but nothing severe. My labs for this year, 2004, have been (CD4, VL, %) 310, 40.400, 16 in January, 320, 21.600, 19 in April and 300, 31.000, 17 in September. I am not experiencing any symptoms, work full time, everything honky dory.

My doctor feels that if my next labs come back the same or worse next time (December) I should consider starting medication. His suggestion is Emtriva/FTC, Tenofovir/Viread and Stocrin/Efavirenz.

My questions: Would you recommend me starting treatment? Would you recommend this treatment plan? Is there something better/newer/easier available now or coming soon? Any other options I should consider?

Also, I read that there have been some studies in Africa where people with HIV but not on medication have benefited tremendously from taking certain vitamins, in that it has prolonged their time until they needed to start meds. Do you know anything about this and if so, is this true and if yes, what vitamins were taken?

I dont know if its relevant, but I am in Amsterdam, Netherlands.

Thank you so much for your time and answers.

Response from Dr. Pierone

Hello and thanks for posting. It does seem that based on the gradual decline in CD4 counts that you are nearing time to begin therapy. This can be initiated anytime as long as you are ready. The regimen of Emtriva, Viread, and Stocrin (Sustiva in U.S.) is state of the art. Actually, Viread and Emtriva are now available in a combination tablet called Truvada. This produces a once daily regimen with 2 pills. There is a collaboration underway to add Stocrin (Sustiva) to Truvada and if pulled off successfully, will result in a one pill once daily cocktail.

The African studies showing benefit of multivitamin supplements probably cannot be extrapolated to developed countries because of the vast differences in diet and nutritional status. But it makes great sense to take a daily multivitamin for everyone.



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