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medications - when to start?
Apr 8, 2007

Dear Doctor Gerald ,

I was tested HIV + almost 3 weeks ago and I have started to see specialist and consultant, nutritionist for the past 2 weeks. My first blood test showed CD4 count 363 and viral load count 131,000 H

The doctor told me that when my CD4 count reaches between 200 - 350 should is grey zoen and should go for treatment. The doctor also mentioned that this is my only first test and still does not reflect any significant data / trends of my CD4 and viral load count. He also mentioned that he requires more data on that and advise me to come back in 2 months time to do another lab test. Meanwhile I do not requie any medication.

My question is :-

Is there any possibility that my CD4 count will increase and viral load count decrease these coming 2 months or vice versa? I am panic and do not know what I should do..

Hope you should be able to help me .

Thank you

Response from Dr. Pierone

The CD4+ lymphocyte count may increase more, and the viral load may decline, especially if you were just recently infected. There is sometimes a rapid decline in CD4+ lymphocyte counts with acute infection followed by a rebound and stabilization for a time, although the longer term trend is typically downward. The viral load and CD4+ lymphocyte counts often vary quite a bit from test to test so it may take some time to get a better fix on the status if viral replication and immune function. The CD4+ lymphocyte count percentage may be a more accurate indicator of immune function and should be tracked as well.

It is too early to tell whether you will need to start medications right away, you should have a better idea after you have some more viral load and CD4+ lymphocyte count determinations. The growing consensus is that one should start therapy when the CD4 count drops below 350, although this is not fixed in stone.

If you are nervous you do not have to wait another 2 months, it is perfectly reasonable to have blood testing done sooner in order to have another data point to go by.

Let us know how things go for you on subsequent tests. Good luck!

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