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My love for my Girlfriend
Aug 17, 2005

Dear Doc Remien, Please can you answer my question. Im from the US but i live in Thailand with my thai girlfriend of 5 years. 1 year ago she went and got a tatoo done and 4 months later after being sick she tested pos for HIV. I cried so hard for days for her but decided that i loved her so much i was prepared to stay with her and support her. Im 28 and shes 26. We use the best possible hospital available and her first tests were in Nov 04 533CD4 2800VL the next tests in May 05 were 467CD4 3900VL. Now the doc said this was good news meaning the virus is not progressing fast. Do you agree?? Also what type of drugs would you recomend for her when she has to start taking meds? The doctor said to start meds when her CD4 drops below 200 and her VL goes above 20,000 why do i read on your website that meds should start at CD4 280 and VL above 55,000 ? I am worried that she might start meds to early and the virus become immune to them. Can you advice please. Also its been nearly 1 year since we made love it breaks my heart i love her and hug her all the time and keep telling her she will have a normal life with me. I am sure you must be happy that i can do this with my life and help her. All i want is her to have the best possible care, medication and life she can have. You might not have much experiance with the Thai system but they seem like they know what to do but a little help from you would be so much appriciated. I thank you so much for your time and help you provide to people around the world. Kind Regards. A worried Boyfriend.

Response from Dr. Young

Thank you for your post.

Many of us here at were fortunate to visit your lovely country last year for the World AIDS Conference.

I'd summarize your girlfriends lab work to say that she has a healthy CD4 cell count and a relatively low HIV viral load. As such (and as evident by her labs), she shouldn't need to start medications for some time. Yes, this is good news.

There is some debate about the optimal time to start medications, though there is agreement that if the CD4 count is below 200 or if the patient has severe HIV-related symptoms, then treatment should be started. There are many (self included) who prefer to start treatment in patients who have access to medications and are able to be adherent, when the CD4 count is higher-- around 350. Patients with high viral loads are at greater risk of more rapid CD4 cell decline, and as such are sometimes recommended to start with even higher cell counts.

Today's medications can be very potent (avoids drug resistance or, as you put it, "immune") and well tolerated. The best medications for an individual depend a lot on local availability of drugs (such may be the case in your Thai city) and the particulars of her other health-related issues. The Thai system is quite good and I suspect that she has access to very qualified healthcare providers and medications.

Good luck, boyfriend. Keep us posted. BY

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