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Should I start treatment???
Dec 31, 2004

I am based in London (UK).I was diagnosed positive over 12 years ago. My last counts were 290 cd4 and 125,000 VL -it has fluctuated over the years but it is definately dropping. I have constant myalgia (legs), recurant herpes (take acylovir daily), constant diarrhea, sleep disruption and general tiredness. I had pheunmonia earlier this year which left me with a bad cough which lasted for months. It took 3 types of antibiotics to rid of and returned earlier this month and has responed well to more antibiotics.

My doctor in London has not suggested any medication programme at all and she seems to think that I'm not ready at this point. From reading your experts' advise I feel that if I was in the US I would be on meds by now.

Am I receiving good treatment and will a delay in being put on meds have an effect upon my long term health?

Regards Hoxton

Response from Dr. Young

Thanks for your post.

There are some differences in opinion between the US- and UK-based physicians about the optimal time to start treatment for HIV. To overly generalize, US physicians tend to start patients when their CD4 counts are below 350; UK doctors tend to wait a little longer, but both strongly recommend starting treatment when CD4s are below 200. Additionally, both sets of treatment guidelines speak to the treatment of patients with symptomatic HIV disease, irrespective of their CD4 cell count.

In your particular circumstance, if you were my patient in the US, I'd be considering starting-- given that you have some chronic, mild- to moderate symptoms.

I don't think that you are necessarily receiving bad treatment, but rather are in this in-between zone of the two countries' doctors recommendations.

I hope this helps.

Good luck, have a happy and healthy new year. BY



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