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starting treatment uncertainty
Apr 2, 2010

I am a 50 year old male who seroconverted in Jan 08. My cd4 count has been consistently in the 800s and my viral load which was as high as 8000 is now 500. I take vitamins and exercise often. I have a close friend who is a well known MD and feels strongly about me starting meds while my #s are good. My Doctor disagrees and says either a cd4 count below 500 or a load above 50,000 warrant meds but feels strongly I shpuld wait. How should I decide? I feel great otherwise.

Response from Dr. Young

Hello and thanks for your post.

It's always a little bit challenging to be the third opinion, but I'm with your friend.

While your counts and viral load are ok, the "ok" is based on estimates of healthy ~20-something men. A few comments, first, the current treatment guidelines state acknowledge the disagreement of experts about the benefits of starting with CD4s about 500; they also note that persons over 50 (or for each 10 years of age), the risk of having a HIV complication increases. IMHO, there are concerns about other issues- cancer, heart and bone disease to name a few, where the risk of having a complication increases with HIV and age.

Taken together, if you have no compelling reason not to be on medications and are willing to take and adhere, if you were my patient, I'd suggest (but not strong arm you into) starting in the relative near future.

I hope this helps.


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