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Can I wait a little bit longer?
Aug 21, 2005

Hi,

The amount of information provided by you on this website is just incredible. I wonder if you can give some ideas regarding my situation.

I was diagnosed 6 years ago, with a CD4 count of 250. Since then the CD4 count has been between 200-350, and the viral load never higher then 5000. In particular the last 3 results were: CD4 %CD4 Viral load 20 months ago 221 13 4500 14 months ago 193 16 2150 2 months ago 245 13 1400

I am feeling fine, in good health, take multi-vitamines and sport regularly. My doctor is suggesting to start medication, or if I don't want to start, take at least Bactrim.

I am looking at it differently. I realize that my count has gone down slightly over the years, but given the slow progression, according to me I should be able to stay at least another 1.5 years without medication. Obviously I will check at least every 6 months, as I realize I need to monitor my health closely, and if the pattern changes I will have to start medication. Do you think I am being stupid here, and would you advise immediate start of the medication anyway, or do you think it is reasonable to try to prolong my life without medication as long as possible?

If I will not start any medication for now, should I start taking Bactrim, or would it be ok also to wait with this a little bit longer? My understanding is that Bactrim will just prevent the possibility of PCP, but will not do anything for my CD4 count or generic health (besides maybe some unwanted side-effects).

And another question, if I would start Bactrim, can I stop taking it anytime (for example in case, I get bad side-affects by using Bactrim) without any fear for my continuous health? As with most of the other drugs, you should adhere 99% and not stop your treatment at anytime, as this might have the opposite results, of creating resistance in your body against the drug.

Response from Dr. Young

Thanks for your post.

I'd agree with your general assessment that you don't have a mandatory need to start medications immediately. Getting clinic and lab work monitoring is really important if you choose this path. With a CD4 percentage less than 15% or having had a CD4 count less than 200, I also agreee that taking Bactrim to prevent Pneumocystis pneumonia is worthwhile. You can stop the Bactrim when your counts rise back into a safe zone (presumably when your on antiretroviral medications); adherence to Bactrim is less critical than that for HIV medications, though I'd be remiss to say suggest that even adherence to Bactrim isn't important to your health.

Now, if you were my patient, I would try to address and understand your reluctance to start HIV medications. Further, I'd be recommending starting treatments as soon as you were willing; if I were a patient in your circumstances, I would start on treatments today-- in order to prevent AIDS complications or risk increasing the possibility of medication-related complications.

If you're really interested in prolonging your health and life span, I'd start soon.

I hope this helps. BY



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