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Anxious about the new guidelines for starting treatment question
May 26, 2006

Hi,

I was concerned about the question and answer to the "New Guidelines to Starting Treatment" question.

The questioner said that "After a median of three years observation, the risk of either progression to AIDS or death was almost three times greater in the patients who began treatment with CD4 counts of less than 200 compared to the group in the 201350 range. Those who had CD4 counts above 350 had a 26% less chance of progression to AIDS or death when compared to the mid-range group"

Can you just clear something up for me. If one has had a steady decline in CD4 count to 350 and then started medication, what is the life expectancy. I know that every case varies, but I had understood that the CD4 count often rebounds and the prognosis with current day medication may be say another 7,10 or (with advances in medication) even 20 years of good health.

It was possible to read that question and get the impression (possibly wrongly!) that one might be in one last's three years of life.

Can you give some reassurance please to those with HIV, particularly those who adhere well to their medication regimes.

Response from Dr. Wohl

When therapy is started at a CD4 cell count above 350 fare the best, according to several studies. I would really move away from that 7 to 10 years prognosis stuff. That estimate is based on old data and no longer relevant. Those who start meds at a CD4 of 350+ and take their meds as directed have an excellent chance to live decades.

DW



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