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Why are they waiting to start tx?
May 13, 2007

My brother is an inmate in TDCJ. He was diagnosed hiv+ 6 months ago. What are the indications for starting antivirals? They told him his, I believe cd4 count, had to drop below 200. Is this the standard of care? Or TDCJ/UTMB standards? I thank you in advance for any insite you may have on this matter.

Response from Dr. Wohl

In the US, in prison and out, the standard of care is to start HIV therapy when:

1. CD4 cell count is 350 or less 2. There are signs or symptoms of advancing HIV infection such as an opportunistic infection, weight loss, night sweats, etc.

Plus, many will consider starting HIV meds if the viral load is very high (>100,000) despite a CD4 cell count greater than 350.

I am pretty sure the folks in Texas follow these guidelines. Now, medications to prevent major infections like PCP are indeed started when the CD4 count is less than 200.

If there is any confusion, you or your brother can talk with prison medical officials.

DW



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