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Viral Load
Dec 14, 2009

I talk with other HIVers on this site and other websites. This guy is constantly telling me I should be on HIV meds. I tell him my doc wants to wait. Even though I'm pretty sure I've been infected several years, my CD-4 has been above 700 and viral load usually below 15,000.

This guy is very big on starting meds right away. I think he started right after infection. He told me a viral load over 1,000 is terrible. My docs say my numbers are great. They say a viral load under 20k is awesome. They've actually said they wouldn't worry until viral load gets above 100,000 or CD-4 dropped.

I know it is obviously better to be undetectable. However, until you start meds, that is probably not likely unless you are a Elite controller. Is a viral load consistently under 15,000 "terrible"?

Response from Dr. McGowan

Thanks for your question. A viral load of 15,000 is on the lower end of the scale. True it is not in the range of an elite controller. Most decisions on starting treatment are based on the CD4 count and not the viral load. Very high viral loads may prompt earlier treatment initiation because they are usually linked with more rapid CD4 decline...so it is just a matter of time before treatment would be started anyway..a few months earlier is not a big deal in the scheme of years/decades of treatment. There is a very heated debate now about the dangers of letting HIV grow unchecked over the course of many years. This is due to the fact that the virus (both directly and through inflammation that it causes) can cause damage to the immune system and other organs such as the blood vessels, brain, and kidneys. Most people are moving to start treatment sooner...current guidelines make a suggestion to treat above 500 (with a more definite statement about not letting the count go below 350). Until more definitive data are available it is really an individual decision based upon your belief in the medications and commitment to treatment. You have hit upon a very hot topic and should discuss it in detail with your doctor...your own personal history including the other medical conditions you may have and your age could push the pendulum in one direction or the other for you.

Best, Joe



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