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UN-INFORMED
Aug 28, 2008

Dear Dr

I am age 62 living in Thailand and have been HIV+ since 2006. Aug 2006 CD4 = 553 Viral Load 200,000. Feb 2007 CD4 = 479 Viral Load 264,000. Sept 2007 CD4 = 695 Viral Load 500,000 Jan 2008 CD4 = 523 Viral Load 170,000 Aug 2008 CD4 = 357 Viral Load 171,000 I have been seeing the same doctor here since 2006 and have informed him that I have been reading all the latest reports from THE BODY and that the new recommendations in the USA, Europe and the UK are to start treatment around 350 or if the Viral load is high or you are older as I am, or in my case have all three to witch I fit the category. I am still very fit for my age, have no fat on me, am 61 Tall and weigh 95 Kilos. I have some tingling in the toes and finger tips; I take 1x300mg Neurontin capsule before bed for this.

My problem is, my doctor insists I do not start treatment until CD4 is 200/250 he said that is when they start in Thailand and he would then put me on what he calls a cocktail? 3 in one of something that is what they dish out here. He informed me that the Thai medical board has not informed him of the new recommendations mentioned above.

What do you recommend I do, start on medication now and if so what type of medication should I start on. Do I have to have any tests to check anything before medication, WORRIED.

Response from Dr. DeJesus

Dear worrier:

Unfortunately, if the health system in Thailand is providing your care and meds, your doctor may be bounded to their set of guidelines and recommendations. I agree with you that waiting until your CD4 decrease to 200-250 is not in your best interest. You are also right, that new European guidelines recommend to start treatment earlier.

In addition you have five other strong factors for consideration in initiation of therapy:

1. You HIV VL is very high 2. Your CD4 count is decreasing over time 3. Your age 3. You are starting to develop some peripheral neurological symptoms (that may/ maynot) be related to your HIV disease 5. You appear willing and ready to start medications.

Considering all those factors, I would probably recommend to start therapy at this point. If your doctor is bounded to follow specific guidelines and recommendations, at least try to see if they will compromise and at least allow you to start at a CD4 count <350 cells. Good luck!



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