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On and off therapy
Jul 4, 2006

I have been HIV positive since Nov 1997. I started right then with treatment. By June 2001 I stopped taking medications, and only testing every 4-6 months, my CD4 have always been above 400, but lately my viral load went up to 150,000 - my doctor decided to put me back on medications. For how long should I be under treatment until I can let my body be "alone" again ? Is this a good/wise thing to do?? Allow you body with no medications for a period, in this case was a long period, 2001-2006. I am so grateful for you providing this service. It is really a big support, emotionally especially, to know there are people like you around us !!

Response from Dr. Pierone

Hello and thanks for posting.

The best course of action for HIV-infected individuals with a CD4 count above 400 is not known. The formal DHHS guidelines would advise a watchful waiting approach as long as there are no HIV-related symptoms.

There has been some emerging sentiment among HIV thought leaders that perhaps we should be treating HIV infection at an earlier stage instead of waiting for the CD4 count to drop to 350. Some clinicians and patients are already starting treatment at higher CD4 count thresholds, especially when the viral load is greater than 100,000.

In your case, the decision to start therapy should be in collaboration with your clinician. Likewise, the decision to stop therapy at some point in the future should be in partnership with your doctor and will based on your overall health, CD4 count response, viral load results, and tolerance of medications. Also, the results of future studies will provide more data to better guide treatment decisions. Best of luck and let us know how things go.

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