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Should I start HAART?
Nov 29, 2010

Dear Doctor, I am from India. I have lived a straight life and have a family. I work as an Optoelectronics engineer. I was detected as HIV+ in March 2010 with CD4 count as 478 & Viral load (PCR-RT) as 1980. I was told to do 6 monthly tests for CD4 and come back when CD4 is around 300. Then ART would be started. I started taking good diet of Vitamins & Spirulina. I got a test done again now in Oct. Now the CD4 count was 575, but my PCR-RT result showed a viral load of 60000+ !! Should I go back to the doctor - there is only one hospital here with long long queues - also, if anybody comes to know, my family & job is doomed. How close I am towards death?

Response from Dr. McGowan

You are doing the right thing by having your viral load and CD4 counts monitored closely. It is always important to have testing repeated because variation can occur in the test results. Some of it is the normal up and down of the CD4 count and viral load and some is due to inaccuracies of the tests. A viral load may vary up to 3 fold just due to testing variability. So there is a more significant difference between your first and second viral load values. If you were recently (within 2- 4 weeks) sick with a fever or had received a vaccination before the second test that could drive up the viral load. A third test should be done now to determine where you viral load really lies. The height of the viral load will determine how quickly your CD4 count may drop and help plan for when to start treatment. Having a low viral load like 1980 could take several years before treatment would be needed and follow-up every 6 month may be OK. If the true viral load is higher (around 100,000 or higher) than treatment may be needed sooner. Right now your CD4 count is alright so nothing is urgent, but getting a repeat test (before another 6 months) would be important to help to make plans.

Best, Joe

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