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Viral Load Baseline and Plan for Testing
Oct 25, 2005

I am a 56 year old WM, and just tested pos. I believe I have been infected for about 5 months. My CD4 is 841 and viral load 214,000, with Log CPS/ml at 5.3.

Is it important to get a second viral load test in 2-3 weeks to establish a more accurate baseline?

My plan is to continue to check CD4 count and viral load every 3-4 months and wait until my T-Cell Count is about 400 to start treatment. Does that sound like the best decision to make?

Are there any other tests I should be getting on a regular basis?

Thanks a lot!

Response from Dr. Pierone

Hello and thanks for posting. I generally do order a second viral load and CD4 count within a few weeks of diagnosis to establish a bester defined baseline and then check every few months thereafter. Starting therapy around 400 CD4 cells would be fine. The authoritative guidelines suggest starting treatment in the 200 to 350 CD4 count range. However, the guidelines that pertain to timing of therapy are based mainly on observational studies, not randomized controlled trials. Observational studies by their nature are subject to biases of all sorts, but may still be extremely helpful and impel us towards scientific truths. So this range is the best estimate of experts based on what we know now. I do think that in the future the guidelines will probably call for earlier treatment.

Monitoring tests for a 56 year-old male include tests for co-infection for Hepatitis A, B, and C. Vaccination for Hepatitis A and B will be performed if necessary based on blood tests that can confirm previous exposure and immunity. A yearly blood test for syphilis is indicated (unless abstinent). A yearly PSA test for prostate cancer makes sense as does a yearly measurement of testosterone. A test for colon cancer screening - colonoscopy every 7-10 years (if no polyps of family history of colon cancer) is recommended. Periodic checks of routine blood tests (glucose, kidney tests, liver tests, etc) should be performed. Tests for previous exposure to CMV (cytomegalovirus) and toxoplasmosis are often checked, mainly to have this information available for possible future use. Cholesterol and triglyceride testing should be done at least once a year. A rectal examination to check for papillomavirus infection and prostate nodules should be performed once yearly as well. There are probably more, but this list covers the basics. Best of luck to you and let us know how things go!



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