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Should I start my treatment?
Mar 18, 2011

Dear Doctor, I was detected as HIV+ in Mar, 2010 with CD4 count -478 & Viral load (PCR-RT) as 1980. I was told by AIIMS (All India Inst. of Medical Sciences) 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 - in Oct (CD4 count-575, viral load- 60000+) & Feb (CD4 count-472, viral load- 253,451).

I am from India. I have lived a straight life & have a family. Not sure when I got infected & how...Should I go back to the doctor now - there is only one hospital here with long long queues. Once I start my meds, I would have to tell my company & will risk loosing job. My kid is also very young. I am worried - not sure if I would live long enough to help her grow-up. I want to buy a house for my family - this is the least that I can give them. I need another year for that...

Need your advice desperately.

Best Regards,

Response from Dr. Young

Hello and thanks for your post from India.

While each country may have its own specific HIV treatment recommendations, you should be aware that the current US treatment guidelines suggest treatment when CD4 counts are below 500. The most current (2009) treatment guidelines from the World Health Organization differs somewhat and recommends treatment when CD4s fall below 350.

Separate, but related, some guidelines use HIV viral load as a factor to consider. Your last viral load is quite high and perhaps indicative of more rapid disease progression.

Minimally, I'd advise getting regular laboratory monitoring; if you develop any symptoms, you should bring this to the attention of your doctor.

You have all the potential to live a long life and watch your child grow up. It will likely require medications at some point in the near future to preserve your health; hopefully doing so won't jeopardize your confidentiality or your job.

Best of luck, BY

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