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Should I start treatment
Dec 23, 2006

In Sept. 06 I found out I have HIV. I have had two test done - (1st) 363 cd4 and viral greater than 100,000 (2nd) 452 cd4 and viral greater than 100,000. I am 48. My doctor has recommended Atripla. Should I wait to start? What are the advantages and disadvantages of starting early? Should I consider another medication? I am heavy set about 305 - What impact will the medicine have?

thanks RS

Response from Dr. Pierone

Hello, and thanks for posting.

The advantage of starting early is that unchecked HIV infection is not a good thing and may result in a loss of immune function which may not reconstitute later on when therapy is commenced. There is also a lower risk of transmitting HIV to an intimate partner in the case of a condom failure.

The main disadvantage of starting early is that medication related side effects may occur. Also, if adherence is spotty, then drug resistance may occur and this will reduce future therapy options.

Atripla is a very attractive starting medication since it is one pill, once a day. It has been shown to be very effective and is the standard to beat for any new frontline HIV regimen. Many people experience neuro-cognitive side effects from the Sustiva component dizziness, fuzzy-headed sensations, sleepiness, are examples. These side effects usually go away within weeks to several months. But some people never get over it, or develop a worsening of depression and need to change to something else.

It is highly effective and the expectation would be for your viral load to become undetectable and the CD4+ lymphocyte count to progressively improve.

Best of luck to you and let us know how things go.



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