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Jumped VL count
Jan 21, 2005

Hello, Should I wanted a second opinion on starting treatment. My viral load is at 31,800 and my CD4 count is 445. In October my viral load was 8,390 and my CD4 count was 384. It seems that my viral load jumped quite a bit in three months, should I start treatment, even though my CD4 is average, I would like to get my viral load down as soon as possible. Or maybe should I look into any trials? Thank you.

Response from Dr. Pierone

Current guidelines suggest that you may safely defer treatment with a CD4 count above 350 cells. Viral loads do jump around quite a bit and you will get a better sense of the range of your viral load with future blood tests.

There is a clinical trial called SMART that is comparing immediate treatment with HAART versus delayed therapy. The delayed (or deferred) treatment group starts treatment when the CD4 count goes below 250 cells and then stops when the count increases to above 350. In essence, this group has CD4 count driven therapy. In contrast, the immediate therapy group has continuous treatment with the goal to keep the viral load undetectable. But participation in SMART is really only for those who are comfortable with either approach outlined above. This is a randomized study so the participant (or doctor) does not get to choose which arm of the study to enroll in.

It is not unreasonable for someone with HIV infection to consider starting treatment with more than 350 CD4 cells. Nor is it unreasonable to wait until the CD4 count gets as low as 200 cells before commencing therapy. We simply do not have robust data that demonstrates which approach is better. As a result, most clinicians try to find the middle ground and recommend starting therapy in the 200 to 350 CD4 count range.

Thanks for posting and good luck to you.



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