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Just diagnosed, BAD counts, Dr. pushing research on me
Jun 24, 2005

I am 27 years old, and I was just diagnosed with HIV last Wednesday. I got my counts today, and from what I can tell, they're HORRIBLE. 164 and 52,000 were my counts. I have some resistance (V179D).

My doctor said that I should start on meds right away (although he can't meet me with me again for three weeks). He was pushing that I get involved in a study. I don't know that I feel comfortable with that. He suggested one of these four combinations of meds:

Combivir + Norvir + Reyataz Combivir + Sustiva Truvada + Norvir + Reyataz Truvada + Sustiva

Any advice? Should I get involved in a study with my counts being this bad already? And shouldn't my doc be pushing these meds sooner? 164 is horrible, right?

Also, related question, what can I expect my counts to rise/lower to if I'm starting out this low?

Response from Dr. Wohl

There are several issues that you raise:

Should you start HIV therapy now?

Yes. But a 3 week delay is not a big deal. Your CD4 cell count is unlikely to change much at all in that short period of time. Your numbers, while not great, are not horrible. A CD4 cell count of 20 and viral load of 600,000. Horrible.

What should you start?

All the listed combinations look good. Combivir is twice a day and Truvada is once a day. That can be important for people who may have trouble taking meds more than once daily. One recent study conducted by the makers of Truvada has shown both Combivir and Truvada, when each is combined with Sustiva, do a great job of getting the viral load low and CD4 to increase but the Truvada patients had less side effects and a bit more success in getting to undetectable HIV levels. There are more data on use of Sustiva than for Reyataz with Norvir as first therapy but I suspect they will all work well - meaning, your CD4 cell count will climb as your viral load drops. That is, if you take the meds without fail.

Should you do a clinical trial?

This is up to you and depends on what meds are being offered (are they the same as those listed?), the benefit to you (covers cost of meds and labs), the time committment (is it more than if you were just prescribed meds by your doctor), your desire to contribute to an improved understanding of the treatment of HIV and your trust in the people doing the study. You alone can make that choice and if you are feeling pressure from your doc, tell him/her to back off.

Talk this over with trusted friends and/or family. Get involved with a local AIDS Service Organization. They can share their experiences and support you as you deal with your recent diagnosis and tough decisions you are facing.

Lastly, regardless of anything else, you need to be on medicine to prevent PCP pneumonia at least until your counts get back up above 200.

DW



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