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The right time to start medication
Oct 21, 2009

Dear Dr

My partner is HIV positive and he is not keen on taking medication. When we first found out about his status his CD4 count was 90 and now it over 500. We did this by making sure that he lives a healthy life and he also takes vitamin supplements. He is very optimistic and believes that he doesn't need any medication yet. I dont want him to start medication too late. When should we start worrying about him taking medication? Another thing, he has been taking tests to detect his viral load but whenever he has to get the results he makes all sorts of excuses. Is it unsafe for us not to know his viral load or should I not worry since his CD4 count keeps on getting high?

Response from Dr. McGowan

Thanks for your questions.

Your partner's feelings are very common and he is going through alot of emotions in coming to terms with having HIV. Many people do not like to think about it and cannot accept it. He may have been diagnosed shortly after being infected in which case the CD4 count can dip down and back up again as the infection "settles in". This is then followed by a steady decline over time. The speed of the decline will be determined by the height of the viral load.

Right now his CD4 count is OK at 500. We would usually like to start treatment if the count drops below 350. But now is the time to deal with acceptance of the diagnosis and turning a bad situation into a more bearable one. He will not be ready to fight back against this infection if he does not come to terms with it. Luckily he has time to work on that now.

The viral load measurement is important because it is a useful marker of how fast things may change...If the viral load goes higher it may mean that that CD4 count will start to drop more quickly and he will have to be monitored more closely.

Also I hope that his acceptance issues do not keep him/you from using condoms and practicing safe sex.

Best, Joe



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