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Meds now or later?
Oct 27, 2005

I just found out I have hiv. My cd4 is 446. My doctor said I won't even start meds til I fall to 200 or lower due to the virus being able to mutate. Is this normal or should I find a new doctor?

Response from Dr. Pierone

The CD4 count range at which medications are usually started is 200 to 350 cells/mm3.

One of the arguments against starting earlier is that if adherence to the regimen is not excellent, then viral resistance to the medications may develop. If viral resistance does come about, cross resistance to at least a few of the other available medications also occurs, and this reduces future treatment options. Second and third line antiretroviral regimens tend to be more complex and toxic, so the road of viral resistance is one that we don't like to see anyone travel down.

Nonetheless, some doctors and patients choose to start therapy when the CD4 is higher. This decision should be made after weighing all of the arguments pro and con. But even more important is the need to coolly assess ones ability to commit and adhere to a daily antiretroviral treatment regimen. Best of luck to you!.



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