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Starting Treatment
Jul 17, 2007

Hi All

First - I'd like to thank you all for this website, the service you provide is invaluable and comforting. Thank you again.

I wirte to you to get some feedback on starting treatment. I was diagnosed in Nov 2002. Since then - my VL has been between 3,000 and 30,000. One time - it went to 44,000 in Jan 2005. In Apr 07 - the VL went to 45,000. In Jul 07, it's now went up to 127,000. The tcells were 470 in Apr 07, and 430 in Jul 07. Before Apr 07, they were above 500. My doctor is recommending that I start treatment. I have no OI's, have good energy levels. I have been treated for Syphillis and anal warts recently, and have had bad allergies, and a rash that recently developed a year ago and never completely went away. I'm afraid to start treatment for 2 reasons :side effects, and fear that I might not be able to be 100% adherent.

What are your thoughts? Do you recommend I start treatment?

Many thanks.

Response from Dr. Wohl

I see no urgency to starting HIV meds. Your CD4 cell counts are decent and seem to fluctuate. There may be a downward trend in you counts and when you get closer to 350 or so consistently, I would then feel more of a need for you to start.

The viral load can be a tricky test. The variability of the assay means that a result of 50,000 copies/mL could be no different than a result of 100,000 copies/mL. In general, a three-fold variability of the result can be accounted for by biological and laboratory reasons. Therefore, the same blood specimen run three different time can give results that can range quite widely. A ten-fold change in viral load is considered a very meaningful change.

As you will eventually need to start HIV meds, it might be a good idea to start looking closely at the reasons you may not be able to be adherent to a once a day regimen (of which there are a few). This may be a matter of life and death for you and working on this before you start treatment will set the stage for success later on.

DW



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