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Very long time survivor
Oct 25, 2005

Hi there,

Nice weather here in paris france ! I have been 18 years HIV without treatment and of course I would like to be able to be "immortal" ( as Pr Rozenbaum) said to me. My CD4 a falling very slowly since 18 years 1000 to 291 now. My viral load is stabel since 4 years around 80000 today at 95000 what should I do start , not start ? as you can feel I tried hard not to start ! now if I start I wlould like to have it simple and avoid any side effect as possible who would change my body shape. I never experience any HIV side disease except very moderate mouth candida but since the beginning 18 years ago. thank you for giving me from usa the latest news naive treatment if you think I shold start after 2 nd monitoring. Richard

Response from Dr. Pierone

The general expert opinion is that treatment should begin somewhere in the 200 to 350 CD4 count range. Simply based on guideline it would be reasonable for you to start treatment. But your situation is somewhat unusual because of the slow progression despite the relatively high CD4 count. There have been reports in the HIV scientific literature of long term non-progressing patients who had high viral loads. Studies of the viral isolates in these patients showed that these viruses had a variety of different genetic defects that resulted in a reduction in their virulence. In your case, since the rate of CD4 count has been so slow it would be perfectly reasonable to wait longer and have some more CD4 count and viral load levels done and defer the treatment decision for a bit.

What to start with? One of the more popular starting regimens in the USA is Truvada (Viread and Emtriva) and Sustiva (efavirenz). This regimen consists of two tablets once daily at bedtime. Soon all three medications will be co-formulated in one pill. Hope that information helps and best of luck to you!

Treatment Naive vs. Treatment Experienced
Viral Load Baseline and Plan for Testing

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