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Thanks
Aug 27, 2008

Dear Doctor,

thanks for your kind reply to my thought on early treatment: your answer was most helpful!

Please allow me another question: my CD4 cell count is stable just over 500; however, my CD4% is between 25-26 (which i understand being the equivalent of an absolut count of 350 ca.). My viral load is around 50,000 and I am asymptomatic.

What to do? Which number shold I follow?

Thanks again!

Louis

Response from Dr. DeJesus

Louis:

There is no a straight forward answer for your question because the decision on when a patient who has such good CD4 numbers, as you do, is extremely individualized between patient to patient.

We take in consideration many other factors such as patient's understanding, education, resources, likelihood of adherence, drug/substance abuse, pregnancy, comorbid conditions, progression of disease (for example, how much the CD4 count has decline in the past year), patients state of mind (how is the patient coping with the diagnosis), sero-negativity of a partner, persistent risk factors to pass this infection to others, and lastly how willing the patient is to commit to treatment.

There is already evidence of benefits for patients that initiate medications even at CD4 count >350, and potentially even > 500 cells. I will not recommend for everyone to start at CD4 above 500, but certainly there are some patients that could benefit from an earlier initiation of treatment. If it is me, I will probably startbut I respect that this decision needs to be personalized and individualized.



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