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Aug 18, 2007

Hi doctors! First of all, thanks for all the great effort you put into soothing our ails and doubts... Being poz is perhaps equally taxing on the mind than on the body, your answers at least can take away some of the fear and doubt. I just came back from my HIV specialist. I've been poz since september 2005, diagnosed october 2005, CD4 has always been in the high 400's to 500's at a pretty stable 26% (give or take a percent or two). Today, the percentage plunged to 17%. Same lab, same technicians, with a CD4 of 430. The CD4/CD8 ratio also reflects the drop in absolute percentage of CD4's. In stead of the trimestrial visits, i've been given an appointment in 3 months, to re-assess this drop.

Here (in Belgium), for some idiotic reason, truvada is not available (tho it's constituents are available separately), and the most likely combo i'd be put on is sustiva/stocrin + truvada OR sustiva + kivexa (part of a trade off study).

Dear doctors... a penny for your thoughts... at 17%CD4, should i be doing bloodworks earlier than in 3 months? Would you advise treatment if these results are confirmed, or only if they worsen?



Response from Dr. Young

Hi P in Belgium,

Thanks for your post. With a CD4% of 17-- something pretty close to the AIDS-defining level of 15%, I'd recommend considering starting treatment in the near future. A repeat CD4 test might provide confirmation (and perhaps peace of mind) that starting is the right thing to be doing.

In every treatment guideline, HIV medication is highly recommended for anyone with a CD4 count of 200 (or 15%), since the risk of having a real AIDS complication goes up dramatically at that point.

I wouldn't worry about the "idiotic" reasons why the Truvada combination isn't available in Belgium, but rather focus on the good fortune that all of the medicines that comprise this or other well-tolerated once-daily medication regimens are available. (It is really the difference betweend taking 1 pill a day or 2-- hardly a reason that adherence should suffer, IMHO.) The options that you list from the study are all ones that we've used very successfully in our patients.

Hope this is helpful. Best of health to you. BY

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