Hello Doc,

With CD4 at 389 and VL at 45,000 Would you start treatment? It is very puzzling since some people recommend early treatment while others stick to the guidelines. How do I decide, what would you do had I been your patient?

Hello, and thanks for posting.

The reason that it is puzzling is simply because we don't have all the pieces to the puzzle yet. We don't have definitive data to precisely inform treatment decisions, and specifically to tell us when antiretroviral therapy should be started. So in the absence of definitive data, we are left with opinion, and opinions are like noses, everyone has one. Consensus guidelines are based on the premise that if you get some of the smartest and most knowledgeable noses together, they can make prudent recommendations based on the most up-to-date information.

So, if you were my patient, I would refer you to the Department of Health and Human Services (DHHS) treatment guidelines for adolescents and adults with HIV infection at this link.

After you had a chance to read this 113 page document we could then reconvene and review the pros and cons of early initiation of antiretroviral therapy. Then, based on your personal health history, and your synthesis of the information, in a shared decision making model we would decide whether you wanted to go on therapy now or wait.

I hope this information helps and best of luck to you!