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when to start treatment
Dec 18, 2006

i was wondering when the proper time to start medication would be for a patient just diagnosed.....i have been doing a lot of reading and there is a lot of debate over this....it would seem to me that a person just diagnosed should wait as long as possible to start treatment because the sooner you start, the sooner you become resisant to the drugs....thus starting later would mean that you would be able to live a longer life because of when you started meds. Also there are side effects of the treatments which is something you would not have to deal with until later when you start treatment. Lastly, for someone just diagnosed today would it be unreasonable to assume that waiting 4-5 years to start meds might mean that better medication might be available within the next 5 years that are less toxic and dont have very many side effects?

Thanks

Response from Dr. Wohl

Much of what you have surmised reflects the quandry clinicians have when determining the optimal time to initiate HIV medications. There is a balance between the need to slow down the destruction the virus is causing to the immune system and the limitations of HIV medications (particularly resistance and side effects).

The good news is that HIV therapies have become more resistant to resistance and are generally well tolerated. At present most all HIV docs would say that it is not how long from when you were infected but what your CD4 cell count is that determines most when to start therapy. At a CD4 of 350 or so, the majority of US docs would start treatment. Some opt to initiate therapy at higher CD4 counts given the potency and tolerability of current regimens.

Keep in mind, HIV causes side effects too. Some of the damage that HIV causes may not always be reversible and there are emerging data that uncheck viral replication is a bad thing, contributing to problems once thought to be due only to HIV meds like cardiovascular disease and liver damage.

I feel therapy needs to be individualized to the needs of the patient. Talk to your health care provider about your CD4 and viral load levels. If they are concerning and you are committed to take your therapy as directed, resistance will be unlikely. And, with two dozen different HIV meds, you are bound to find a combo that you can live with.

DW



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