i am 21 years old ihave hiv since 7 monthes iam not on medication.my viral load in 1/12/2008 not detected but my cd4 was 915 and now 436 (35%)because i tam on interferon and ribavirin and also zefix since 6 monthes.my question if my cd4 stil law and became less than 200 what should i do? in this case i have to start medecation for hiv even iam not detected?or i have to stop interferon?please advice me.thank you.

Hello and thanks for your post.

I'm assuming that you're receiving the interferon and ribavirin for hepatitis C treatment, no?

Based on what you've described, you're fortunate (in a way), to have a undetectable HIV viral load. Most persons like this have very slow HIV disease progression and CD4 cell decline. This doesn't mean that it can't happen, and your recent labs suggest that your CD4 is getting lower.

Having an undetectable viral load doesn't mean that HIV treatments can work, it's just that the usual test that we use to measure success (viral load) will have less utility. Indeed, I have a few patients just like you. I would not recommend waiting to start until your CD4 count falls to 200, but rather, if your counts are dropping rapidly, or are below 350, I'd be considering treatment now.

I'd have a discussion about your interferon treatment goals; it's possible that these medications are temporarily lowering your counts, but I wouldn't bet on it at this time. In most cases, interferon treatments can certainly be continued while on HIV medications.

Please let me know if I can be of any further help,

BY