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when should medication start?
Jul 29, 2009

Recently diagnoised. with cd4 685 and viral load of 700.000. Should I start medication now?

Response from Dr. McGowan

Thanks for your question.

The most important guide of when to start therapy is the CD4 count. Current guidelines suggest that therapy should be started if the CD4 count is 350 or below. Recent studies indicate that 500 may be a safer number. Either way your counts are high enough that waiting would be a reasonable option. Your viral load is high (above 100,000) which may lead to a more rapid decline in your CD4 counts than if the number were lower, so if you do opt to wait, you should have your CD4 count monitored closely. Ultimately the decision of when to start is an individual one when the CD4 count is above 350. A person who is very willing to start therapy and be adherent could certainly do very well by starting early, but will have to deal with potential side effects and staying on schedule when the benefits of being on treatment may not be so strong.

Best, Joe



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