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Treatment in the UK
Jan 3, 2005

Hi I am based in London UK. I was diagnosed HIV 16 years ago and have been well for most of the time. I had a viral chest infection earlier this year and since have had a persistant cough which responded to antibiotics but returned again recently. I have server fatique and feel constantly tired. My CD4 is 290 VL 125,000. I have not lost weight nor have I had any oportunist infections. UK doctor has not suggest any type of regime treatment in fact she seems to think that it should be delayed as long as possible. Does this sound resonable to you? Would I be on treatment if I was in the US?

Response from Dr. Pierone

It sounds like you have had a slow progression of disease based on the relatively good CD4 count after 16 years living with HIV. It would be important to know if this viral load of 125,000 is typical for you or if it represents a one time blip. Also the tempo of CD4 count decline plays into the decision to initiate treatment.

The severe fatigue and persistent cough may be related and perhaps you have a lingering bronchial infection that simply needs a longer course of antibiotics. Or it may be that these symptoms are related to HIV infection. If so, you may benefit from starting therapy. One of the inexact areas in HIV medicine is whether non-specific symptoms are HIV-related or not. Sometimes we have to bite the bullet and start a regimen to sort this out. But in your case, based on your slow progression I would be more inclined to think you may be safe in waiting while looking into the cough and fatigue. In the US, the guidelines have a optional treatment range of 200 to 350 CD4 cells and the decision is left to the discretion of patient/doctor team - unless of course one is enrolled in an HMO, in which case they desire that treatment be deferred as long as possible - preferably after switching to a different insurance carrier :).



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