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Time to start meds?
Dec 6, 2011

I tested positive exactly 2 years ago. At the time I had a CD4 count of 830 and so I felt somewhat fortunate to have a healthy immune system. One year later (in Jan of 2011) my CD4 count had dropped precisely about 100 to 730 which I understand is about the average if untreated. I thought it might be a while before I get to under 500. However, in the last year my drop has accelerated, taking me from 730 to 540 and to 460 by now. This has been really surprising as my viral loads do not seem much higher than they originally were? Is it common for the "slope" of my decline to change so significantly from the first year to the next? I am about to discuss this latest result with my doctor but now I am eager to start meds as i know guidelines do now suggest that counts below 500 warrant treatment. Thank you for your insights.

Response from Dr. Young

Hello and thanks for posting.

You raise some interesting points about monitoring labs and when to start treatment.

First, with regard to your CD4s, I'm not so sure I'd interpret your values as a change in slope (to do so assumes an absolute "truth" in the first differences, rather than the larger trend). Changes in slopes though can occur and are often (but not always) accompanied by an increase in HIV viral load. Whether one assumes an inflection in change or not, the rate of decline predicts that your CD4 decline will continue with time. As such, the interpretation about starting medications soon is both reasonable and well thought.

BTW, current guidelines do recommend treatment when counts are below 500, or for many conditions when CD4s are above 500, including those persons whose CD4s decline at greater than 100 cells per year.

I hope that helps. BY



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