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Whether to start therapy
Jul 29, 2005

Hi Doctor,

I'm a 46 year old man HIV+ for 3 years. My viral load has remained in the 5,000 to 15,000 range. CD4 has gradually declined to round 350 where it has been for about 12 months. My treating GP has consistently said my meds are in the best 5% and I will not have to consider treatment for a long time.

My only HIV related symptoms have been consistently swollen lymph glands in my neck for the last year. 6 months ago, glands in the most swollen side were surgically removed for biopsy - all clear. For the last three months swelling in that side has increased and the treating specialist now recommends starting therapy. He says the swelling is a sign of my immune system fighting the infection but that eventually, the swelling will decline indicating the fight will have been lost and I would be better to knock the virus down now.

This is my only symptom and I am in good health (never get colds, flu or herpes - which always has indicated being run down). For my whole life, my lymph glands have been highly active - up and down like yo yo's and pre-HIV were always a good sign to me that I had fought off any infection.

I have yet to see my GP for his view. But, I am anxious to stretch the period without treatment for as long as possible whilst balancing this with concern not to damage my immune system further in the process.

The specialist also talked about going onto bactrim as a precaution for PCP.

His recommendation all sounded a bit premature to me.

What's your view please.

Response from Dr. Young

Thank you for your post.

From what you've described, you have a relatively low viral load and stable CD4 cell count (at the lower end of the normal range). It also sounds like your doing pretty well, from a health perspective.

As such, I don't see a need to rush into treatment at this time-- with a CD4 count of 350, you have no real risk of developing PCP, hence there's no indication for sulfa (Bactrim, Septra) for prophylaxis.

Your lab work places you at the point where monitoring your symptoms and trend in labs is important, though in a range where some might suggest starting treatment. Given that there has been little downward trend in your CD4 counts, if I were your doctor, I'd be for continuing to monitor your status before initiating treatment.

I hope that you find this helpful. BY

Meds & Albuterol
Is this reasonable?

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