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Keep immune system up or stay of meds til drop?
Oct 24, 2004

Dr. Pierone: My son is HIV+ 1+ years and doing great. On meds from beginning with CD4 now at 1400 and Viral load 0 (never knew what his true numbers were). I spoke with his Dr. the other day about the controversy of staying on meds from the get go without knowing what true numbers are. He said that the thinking again is to keep the immune system healthy and not worry about resistance or toxicity now. He said that there are 25 new drugs in the pipeline and if any of the above should happen we have options. He feels that my son strictly adheres and foresees no future problems. Is it wise in the future to take him off meds and see if what his cd4 and viral loads drop to and then consider restart if needed - or- leave him on meds which I would assume could be the rest of his life? Thank you again for your help in clarifying the so many confusing questions...very much appreicated.

Response from Dr. Pierone

We don't know the best approach for your son's situation. We are attempting to weigh the potential costs (side effects) of antiretroviral therapy versus the potential benefits and we don't have the data to fully inform us on this issue. Nonetheless, every individual must make a decision treat or not. One of the central elements that goes into this decision making process is the original viral load and CD4 count. It would be very unusual not to have this information before starting therapy and I question why this information is not available.

The treatment guidelines use less than 350 CD4 cells as a reasonable threshold to initiate therapy. A number of studies have shown that persons that who began treatment with CD4 counts above these levels can almost always safely stop therapy. If you son chose to stop he would at least know what his off treatment viral load is and this would help him make long-term treatment decisions. However, some people choose to continue and let sleeping dogs lie. I would not put up much of an argument if a patient of mine had a strong desire to continue the regimen despite in spite of the guidelines (after all, they are simply guidelines, not law). Thanks for posting.



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