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At what point should I start HIV medication?
Jun 9, 2010

I was dignosed with HIV 4 years ago. I have not taken any medication yet, my T-Cells are at 597. I was told I need to start an HIV treatment, no matter how how my T-cells are. is this true? or can I continue to wait until is below 300?

Response from Dr. Young

Hello and thanks for your post.

First, you should really never start on medications until your willing and able to take them.

Second, current US treatment guidelines (Dec 2009) recommend considering starting treatment when CD4 counts are below 500 in asymptomatic persons. If you have heart-, kidney or liver disease, most would recommend starting irrespective of CD4. If you're older (say, more than 45 or 50), then I'd consider starting much sooner, rather than later (ie., when counts are above 500).

I would not generally recommend waiting for counts to fall below 350 (or as you've said, 300)- doing so has been shown in several studies to increase risk of drug-related side effects and even increase risk of death. Mostly, the key thing is to develop a trusting dialog with healthcare providers that are well trained and whom you trust.

I hope this helps.

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