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New DHHS Guidelines
Nov 28, 2004

The U.S. DHHS guidelines for when to initiate HAART have been updated.

Allow me to quote the DHHS before I propose my question:

*(10-29-04) When to start? For asymptomatic treatment-nave patients with CD4+ T cell count >350 cells/mm3, the viral load recommendation to defer or to consider therapy has been increased from 55,000 to 100,000 copies/mL. This is based on more recent data supporting HIV RNA level of >100,000 copies/mL being a stronger predictor for disease progression than >55,000 copies/mL, though even at these CD4 and viral load levels, the risk of disease progression is still relatively low. Most experienced clinicians will defer therapy with quarterly clinical and laboratory evaluation.*

My history is as follows:

Diagnosis (9-7-2004): CD4 164, 15%, VL 32,000

(9-13-04): CD4 460, 17%, VL n/a

(10-7-04): CD4 459, 18%, VL 158,638

I have not been and am not on HAART Therapy. I am asymptomatic.

In direct regard to the DHHS statement above, I have a question regarding this statement...

"though even at these CD4 and viral load levels, the risk of disease progression is still relatively low."

I have been given 4 preventative shots (PCP, HEP A, TB, Flu, etc...) and more are to come.

I want my body and mind to "naturally adjust" to both the news of my diagnosis and the amount of preventative shots I have been subjected it to in such a short period of time.

If you notice how my numbers jumped around during this diagnostic phase, you can see why I am wanting to get more results before initiating anything.

In this case, my gut instinct may have been right - to not start Rx therapy just yet.

How far off the path is my VL 158,638 from the "DHHS" revision to VL 100,000 in terms of "slow progression"?

I do not want to be misguided so I would like an opinion on my numbers, the new guidelines and the "slow-progression" theory.

Thank you, Positive Outlook

Response from Dr. Young

Dear Positive,

Thanks for your post.

If you take a look at your CD4 absolute counts and CD4%, you'll see that there is a pretty big variability in the absolute count, but relative similarity with the percentages. This later parameter suggests to me that there really hasn't been dramatic changes in your immune "health", so to speak.

Having a viral load that is well over 100,000 makes it very unlikely that you'll be a slow progressor. Moreover, though current DHHS guidelines talk about the relative and immediate risk of having an HIV complication, it is pretty clear in my reading of the literature that persons with higher viral loads, like yourself, are more likely to have faster (not slower) than usual declines in their CD4 counts.

I hope this helps, good luck. BY



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