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When to start treatment?
Mar 23, 2005

Would you recmmend that I start treatment

Last 2 labs Date CD4 VL CD4% 01-18-04 1446 >100,000 30's 03-15-04 1091 >100,000 30's Prior Labs CD4 741-870 VL ~50,000 CD4% 28-34

Response from Dr. Young

Thanks for your post.

Assuming that you're asymptomatic, I wouldn't recommend starting therapy at this time (also assuming that the "04" year is a typo and should really read "05").

While some treatment guidelines use the viral load as a sufficient basis for initiating treatment, most doctors in the US weigh the CD4 count much more than viral load. To me, the high viral load that you have suggests (but by no means proves) that you're more likely to have CD4 cell decline, but both of your CD4 counts are in the high normal range. For many patients, having a large fluctuation in the CD4 absolute count (when the total is above 1000) is not unusual, particularly noting that your CD4 percentages remain above 30.

Good luck, thanks for reading. BY

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