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Nov 18, 2007

I Belong to a study since I first found out I was HIV . Been HIv for almost 3 years. Ihad very good numbers for the first 2 years (VL under 1500 , T cells between 450 and 600 and Percent 35 to 30) In the last year I went through major Stress Lost Job , Roommates etc. I drank heavily and smoked alot . I saw my numbers change fast Peaked at VL16,000 T cells fall to 430 and Percent low as 23% . I changed my life (exercise slowed down drinking quit smoking got great new job etc.)the last 6 months (3 test Results later )my numbers changed in the other direction for the better. I got results back today and they are now VL 7100 Tcells 540 and 28% . There is a study that they have and is ending very very soon ( all Drugs FDA approved) Should I go on meds ? Some say Yes ( should have done that long ago)some say No wait to you are closer to the recommended benchmarks. I'm thinking hard about the study so I can put the worries arrest . I freak out every-time I go in to give blood and change my appointments a day or two. (anxiety ) Do you think I'm making the right choice to Start the meds now? What is a good higher benchmark to go on meds? (not waiting to deplete you immune system) FYI I have very strong kidneys and Liver so not to concern about that .Just had test done.


Response from Dr. Pierone

Hello, and thanks for posting.

The guidelines suggest that HIV treatment be started in the 200 to 350 CD4+ lymphocyte count range. However, there is an emerging viewpoint that perhaps we should be starting treatment earlier. Not that we have clear evidence to back up this notion, but it makes sense intuitively. Why wait to treat HIV until after the immune system has been depleted? Two reasons come to mind. The first is that there is a legitimate concern about side effects from HIV medications. The second is that taking medications does involve the risk of generating viral resistance, especially if adherence is not good. One counterargument is that newer HIV medications are safer than some of the older ones. But development of resistance and cross-resistance remains a concern.

So what to do? There is nothing wrong with overruling the guidelines and starting treatment sooner. However, this should only be done if one is ready, willing, and able to take medications with a high level of adherence. Also, one needs to be flexible and prepared to change medications if things don't work out. Some people get very significant side effects from a medication and yet forge ahead with treatment and continue to suffer side effects as a result. So be ready to go to plan B if plan A does not work out.

So in your case it could go either way and there really is no wrong choice. But if you do decide to start treatment remember to be adaptable depending on your response to therapy.

Let us know what you decide to do and best of luck!

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