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Concerned about not starting meds
Dec 17, 2004

Doctor- I tested HIV positive nearly two years ago and have never taken any HIV meds. My CD4 counts vary between 350-450 and viral load has stayed below 10,000. I'm concerned about not taking medication to control the virus. Even though my counts are relatively favorable and stable, the virus must be taking its toll on my immune system. Wouldn't it be wise to start HIV meds to control the virus and become undetectable and to also increase t-cell counts? I would appreciate your input on this. Thank you. From Treatment Naive in So Cal.

Response from Dr. Pierone

This is the 64,000 dollar question in HIV medicine when to start? We honestly don't know the proper time to commence treatment. According to the authoritative guidelines, we don't have the scientific evidence to make a recommendation to start HIV treatment at CD4 count above 350 cells (especially with a low viral load like yours). But it is quite possible that some years in the future we will look back on this era with astonishment and wonder why we withheld treatment for people with HIV infection because we thought their CD4 counts were too high.

The HIV treatment guidelines represent consensus opinion statements (to be fair - evidence based opinion) to help clinicians with decisions. These are guidelines, not hard and fast rules, and don't have to be followed.

Personally, if a patient opts for earlier treatment, I have no problem prescribing it. I am comfortable with this approach because the absence of proof does not mean that a strategy is wrong, and there are certainly some points in favor of early treatment. Potential benefits include preservation of immunologic function and a lower risk of transmission to a partner. Also, one cannot underestimate the psychological benefits that many people experience when they are engaged in a proactive treatment program to gain some measure of control of this disease process. I am not endorsing this departure from the established treatment guidelines, but simply stating that there is some logic to it, and I would support the decision of a well-informed patient to start treatment early. Hope this helps.



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