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FRIEND WAS DIAGNOSED +
May 28, 2010

Doctors, I have a question that I really wanted your opinion on. My friend was diagnosed positive about 3 months ago. He had all his bloodwork done, and his viral load is 10000 but his CD4 count is still 656, which his ID doc told him was excellent. In your expert opinion, is is better to wait to start meds until there is a significant decline in his CD4 cells, or is it best to start right away to better the chance that they won't ever drop below 200? He has spoken with 2 different doctors and they both agree on the newer technique of starting meds immediately. They want him to begin Atripla right now while his CD4s are still so high. I just wanted to know, what is your opinion on this? Do you know if the side effects of Atripla are too great for him to begin so soon? What is his likelihood of survival? His doctor is of the opinion that as long as his CD4s stay so high and if we can get the virus down to undetectable, he can live a normal lifespan. He will just have to have his blood drawn every 3 months and adhere to his medicine regimen and make sure to not miss a dose. Is this true? I am so worried for him.

Response from Dr. McGowan

I would agree with the opinion that his doctors have expressed. We are learning that having virus growing in your body over time is not a good thing. Even if we don't let it go into AIDS..that is just the end of the process. There is likely damage being done even at higher CD4 counts. The main thing is that your friend should be willing to take the meds and make a commitment to treatment. If he is not then he may miss doses or not be strict with his adherence and he could end up in a worse situation...with drug resistant virus. This would be unlikely if he is ready and stays adherent with his treatment.

Good luck, Joe



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