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WHEN SHOULD TREATMENT START?
Aug 1, 2009

A CD4 WORKING AT 14% AND A COUNT OF 685. WITH A 700.000 VIRAL LOAD. JUST DIAGNOSED.

Response from Dr. Young

Hello and thank you for your post.

Most experts recommend starting treatment in asymptomatic persons when their CD4 counts are below 350. There are situations where some doctors consider in addition-- these include having HIV symptoms, HIV-related kidney disease and pregnancy.

Certain laboratory parameters (in addition to the CD4 absolute count below 350) will sometime prompt considering starting-- indeed, ones that you have. First, is having a high HIV viral load (above 100,000 copies/mL), the other is having a low CD4 percentage. Your CD4 percentage of 14 usually correlates to a CD4 absolute count below 200; in my clinic, this is low enough to offer treatment and consider initiation of antibiotics (Bactrim, Cotrimoxazole) to prevent Pneumocystis.

At the least, your CD4 count (and percentage) should be repeated. If your CD4 percent remains this low, I'd recommend starting combination HIV treatment.

Hope this helps, BY



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