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Can I delay treatment?
Dec 30, 2004

Hello. My doctor has been talking about starting me on meds. He has said that lower CD4 counts give more risk of infection and my underlying asthma also wouldn't be good if I were to develop PCP. My viral load isn't too bad--6220, and has been fairly constant around that number. My CD4, on the other hand, has been steadily decreasing, and is now down to 268. I feel fine with the exception of fatigue. I would like to be able to concentrate on school and not worry about meds or side effects (plus I never was the best at taking pills consistently), but I also don't want to get sick again. I look at other's opinions, but I have read those that say it's good to start early and those that say it is good to wait, so I am a bit confused. I was wondering if it'd be wise if I told them I wanted to defer treatment for a while, unless I had a sharp increase in viral load or a decrease to 200 or below on CD4 count? With my low viral load and such, am I really at great risk?

Response from Dr. Pierone

Well, the part of your post about not being the best at taking pills consistently is a major factor in the decision. Various treatment guidelines refer to "patient readiness" in the discussion of whether it is best to start early or later. A component of readiness is the commitment to take medications without fail. I have seen numerous situations in which an individual ends up with virus resistant to virtually every medication available because they began when they really weren't ready, and went about it half-heartedly. Now they are a few years older and wiser, are committed to therapy, but have to take much more challenging regimens because of the drug resistant virus they are stuck with.

With your slowly declining CD4 count and relatively low viral load it seems like you have some time to wait. But when you do begin, consider how high the stakes are, then carefully make a plan to ensure that you can adhere to the regimen. Best of luck to you and let us know how things go.



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