Treatment of Choice?
Oct 19, 2005
Would you start treatment at ALL in the following circumstances, and, if so, which med(s) - assuming no genotyping resistance?
Infected beginning of May 2005, Sep. labs showed CD4 of 654 and Viral Load of 261,000.
Response from Dr. Wohl
Personally, assuming these were repeated and found to be similar, I would probably not start therapy just yet. Others, swayed by the high viral load, would.
In such cases, I explain that the risk of a rapid decline in the CD4 cell count increases with higher viral load. Therefore, if I am able to monitor the patient closely and detect precipitous drops in CD4 cell counts early, I feel secure in watching and waiting.
There is no 'right' answer. If the patient was highly motivated, understood the issues involved and felt strongly about starting therapy early given this viral load, I'd agree.
As to what therapy, any of the standard regimens that we are commonly using as first line therapy in persons with lower CD4 cell counts, be it NNRTI or PI based, would be fine.
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