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Should I start
Apr 8, 2005

Hi Thanks for all your advice in the past - it has been invaluable. I have been +ve for about 9 years but remain treatment naive. Over the last year my counts have been as follows CD4 355, VL75788, CD4 353, VL26139 but my most recent CD4 was rather worringly low at 263 with a VL of only 14200. Is there any reason why the CD4 would have dropped so significantly given that the VL was so low? And more importantly, would you advocate commencing treatment now - had always set 300 as the threshold. Have had recent follow up labs and if they indicate a CD4 of below 300 again I guess I should bite the bullet and initiate therapy - would you agree? Many thanks.

Response from Dr. Wohl

I suspect that if you took all your CD4 cell count determinations over the past few years and placed them on a graph you would see a slow decline in your counts (maybe about 30-50 cells per year?). So it seems inevitable that your counts will continue to drop. The question is at what point do YOU say they have dipped too far?

I would say you are at a point where I would start talking about treatment options and advocate starting HIV therapy. There is no emergency and if you wanted to take a cruise first or wait until the end of Summer, I would not stand in your way. But, the writing is on the line headed south on the graph paper.

Good luck.

DW



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