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Very high viral load
Feb 20, 2005

Dear Dr ! When starting treatment ? Is high viral load dangerous ? I am a Swedish man 48 y old, hivinfection since august 2002. My viral load has varied from 100 000 - 700 000. And my CD4 has been 300-500. In January 2005 my viral load was 700 000 and my CD4 was 380. In Sweden my doctor told me to wait with treatment, but I am very worried about my high viral load. Is it dangerous ? What is your opinion ? Lot of thanks

Response from Dr. Pierone

A high viral load is not dangerous per se, but is associated a more rapid decline in CD4 counts over time. For this reason some clinicians opt to offer earlier treatment for patients who have viral loads that are consistently above 100,000. Physicians tend to start treatment earlier in the United States compared with Europe (pre-emptive aggressive measures are in vogue here now).

Honestly, we don't know the best time at which to initiate antiretroviral therapy (or when to stop for that matter), so individual considerations mean a lot. The medications are so much better now, so if someone is committed to full adherence and wants to start therapy with above 350 CD4 cells, I would not argue for a minute. Hope this helps.

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