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Viremic Controller: Is it time to start meds?
Dec 20, 2011

I tested poz in 1989. I have not taken meds since 1993 (I took AZT, DDC,and DDI for about three years). My viral load had always been <200 and my CD4s between 700 and 1000. In the last couple of years, things are trending down. My viral load is between 400 and 1000 and my CD4s are between 500 and 700. Is it time? What do you think about the one-a-day drug that came out in August -- it begins with a C?

Response from Dr. Young

Hello and thanks for posting.

The decision to start medications can be a daunting one; for those like you who seem to have excellent control of the virus off treatment, even more so.

I'd ask you if there are symptoms of declining health or other medical conditions (heart, lung, kidney or bone health) that might influence the decision. If you're over the age of 50, some are advocating starting sooner (or with a lower threshold).

If your CD4s are reproducibly declining; especially if there is a similar decrease in your CD4 percentages, or if your over the age of 50 AND you're willing and able to take HIV medications, then I'm of the opinion that it's probably a good thing to start treatments.

Which treatments to start requires a detailed understanding of your virus (as for possible drug resistance history), your body (medical history and disease risk) and you (life-, work- and dietary factors).

The medication that was approved in August is called Complera. It's a combination of tenofovir, FTC and rilpivirine. It's generally very well tolerated, but not ideal is you have kidney/bone issues or have a high baseline viral load (you don't). There's much written about Complera on these pages; a simple search will link you to other Q/As.

I hope that helps, BY



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