Hello Dr. Young from France, I've been seeing my hiv specialist for almost 2 years now. She insists on not putting me on therapy until my cd4 drops down to 300. My last count was 330, already lower than 350. Given the fact that the guidelines recommend starting treatment at 350, should I consider finding another HIV specialist? I read in one of your articles for this website that the longer one delays starting therapy the more likely it is to get lipoatrophy in long term. I'm also worried that if I dont start immediately taking medications it will be difficult to restore my cd4 count back to normal levels. Would you agree with my concerns and recommend finding another doctor to start treatment immediately instead of waiting until my cd4 drops to 300? I appreciate your comments. Best.

Bon jour from Colorado, USA.

I don't think that I'd sweat the details (as we would say here)-- the 50 CD4 cell difference between starting HIV treatments between 300 and 350 probably is more academic than worth switching doctors (assuming that other aspects of communication are good).

Different countries view the evidence about when to start with different interpretations- to be honest, I'm not acutely aware of the French national guidelines. We'll probably see further evolution in interpretation of clinical study data yet-- in my opinion, to recommend treatment even sooner in willing and able-to-adhere patients.

I would take advantage of the interlude between now and the time that you will start on medications to evaluate other aspects of your health-- such as vaccinations (for pneumonia, hepatitis and next winter, influenza), heart, liver, kidney and bone disease risks, mental health and the like. Also, take time to learn about your many treatment options; it's my strong opinion that no one regimen optimally fits all patients or all viruses.

Thanks again for posting,

BY