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What s best for starting?
Feb 9, 2009

ZFirst of all I want to congratulate you all for the great work!

Writing from Brazil.I found out positive on September 2008, my boyfriend had the acute symptoms and got tested for all the viruses possibilities. He found out positive so I also took the tests confirming my situation. It was very stressfull time.

When I submitted to Western Blot I also took a CD4 count test, which I was told would be asked later by the doctor.

The WB came back positive and the CD4 was 291 , 14%.

15 days later I took another CD4 test, and viral load to get ready for my appointment with an infectologist, the results were CD4 376 , 15% and viral load 66k.

The doctor suggested I star treatment as soon as possible, and offered me to enroll in a clinic trial and the treatment would be Truvada and Efivarenz or Truvada plus 3TC, but I would have only one week to decide, cause the trials entries were about to end.

My decision was not to accept this offer, I already had too much to process!

First week of January I will have another counting and Im leaning towards starting treatment if there is tendency on a lowering CD4, the treatment in Brazil would be AZT + 3TC + Efivarenz ( the clinic trial entries are over, and there is no Truvada or Atripla available in the country , besides in trials)

Now my questions: how could my CD4 counts get higher in only 15 days , without any treatment? Could all the stress involved affected my immune system?

Was my doctor right in telling me to start treatment, without explaining anything about the importance of adherence, or about the medication, or even asking for any resistance testing? Should I see another doctor which I would feel more confident?

And last: is the treatment offered in Brazil ( AZT, 3TC + Efivarenz) effective, or should I look for treatment abroad with newer meds like Atripla ( wich for me is a possibility )?

Thank you so much for your time, great holydays!

Response from Dr. McGowan

I am glad you are preparing yourself for treatment and reading about the importance of medication and adherence.

The chane in CD4 count from one visit to the next is not unusual. The CD4 count is a very fluid number. It represents the number of CD4 cells in the bloodstream, which can change through the course of the day as the CD4 cells move in and out of tissues to fight infection, get used up and die, and get produced by the bone marrow. Also the test is not exact..the same blood run twice would give a slightly different number..that is there is a variability in the testing process. The overall trends are what is importnat and both your numbers are within the range that would be appropriate to start therapy.

I am not sure that you had the choices of therapy correct on the trial..Truvada + 3TC would not be an appropriate therapy (3TC is very similar to one of the two drugs contained in truvada and would not be used at the same time). Be that as it may, AZT+3TC+Efavirenz is a very good treatment. In a study comparing it to Truvada + efavirenz it was not as good mainly due to the increased rate of anemia in the AZT arm. If you can be closely monitored for side effects it should be OK. If you have access to other treatments from abroad you could explore all your possiilities.

Good luck, Joe



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