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Drug Holiday
Oct 11, 2005

I was diagnosed three years ago during HIV sero-conversion. During that time I was given the choice to start meds or wait. This past month I was advised that it might be a good time to start a drug holiday given the fact my adherence was starting to faulter. I might ad that most of time om meds my Viral Load has been non-detect. with a CD-4 count never below 600 and as high as 1400.

Today I received word that my CD-4 count is 450 with my viral load pending. I must say I am a bit anxiety ridden as a result but have been advised this is par for the course and that a next series of blood work in three weeks will be more indicative of my set point.

What should I be doing now to help my body get through this time from both an emotional and physical perspective?

Also am I putting my health in danger by continuing this holiday?

Response from Dr. Wohl

A drop in your CD4 and an increase in viral load was an expected consequence of your drug holiday. Although you are accustomed to stratospheric CD4 cell counts, a CD4 count of 450 is, as my grandmother used to say, not chopped liver.

I think seeing what the viral load comes back as will be very important from a clinical and emotional perspective. If it is lowish, you may feel reassured that your counts will remain in the 500 range for a long while. On the other hand, if it is high, you may have a low threshold for re-starting meds.

While starting HIV therapy during acute infection is not uncommon, it is hardly standard of care just yet. Further, among those who do initiate meds during recent infection, many are instructed to do so for a set period of time (e.g. 6 months, 1 year, 18 months). It is unclear that there is a benefit to remaining on HIV drugs longer term when they are started during acute infection.

I suspect your health is not in any danger and taking good care of yourself physically and metally can only help. Eat well and mostlyt smart, get into great shape, speak often to trusted friends or to a counselor, go to comedy clubs, help others - these are all things that you can gift to yourself and that can make you feel even better.

DW



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