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Oct 1, 2006

Hi Dr. Wohl, thanks a bunch for all of your help. of my closest girlfriends has contracted HIV from her philandering boyfriend...she was under the impression that they were in a committed relationship but the @#$hole was sleeping around and ended up infecting her. Needless to say, she is completely distraught and really has a difficult time functioning. She has been visiting a good HIV doc who told her that her CD4 counts were steady in the 400 range and her viral load was moderate. He told her that she could be proactive and start medications now before her CD4 count got any lower or she could take the traditional route and wait till they got lower. She doesn't know what to do and we (me along with her other closest girlfriends) don't know what to tell her. What would be your opinion? Her virus apparently has no mutations and is sensitive to all medications so she should have a lot of options. Any advice would be much appreciated...just so we have something to tell her other than "we don't know." Your advice is much appreciated by all of us who have loved ones coping with this disease.

P.S. I hope this doesn't come off as inappropriate, but me and my girlfriends have been looking over this site for a little while now and we're curious to know if you're married or have kids. We've come to the conclusion that in the highly unlikely event that you don't have a family, you certainly deserve someone special. (Not hitting on you, I promise...just a genuine sentiment).

Response from Dr. Wohl

Your friend is fortunate to have such good friends. It is interesting that many US HIV docs hew to the letter of treatment guidelines that recommend initiation of HIV therapy when the CD4 cell count falls below 350. But, when you ask these same clinicians whether they themselves would start treatment at counts 100 or 200 cells higher, most say they would. There is a disconnect here. Not surprisingly, though, we are seeing some movement toward starting HIV meds earlier given emerging data on the consequences of unchecked HIV and the improved tolerability, potency and convenience of HIV meds.

In your friend's case it is important to note that the difference between 400 and 350 is fairly negligible and not worth agonizing over. Given all you write and her likelihood of being super adherent to meds, I would favor starting therapy now. Her counts are already down to less than half of what they probably were before she was infected, she is motivated and otherwise sounds healthy. Plus, she has a great support system.

Thanks for your kind words. I am extremely fortunate and have a wonderful family.

DW



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