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2 nd line ART treatment
Jan 5, 2012

My father is taking HIV meds for about 1 year (current CD 4 count is 143) and there is no increase in CD4 count for the past 6 months. In this visit doctor advised if it is continuing like this, it is better to start 2 nd line ART treatment. Iam very much worried. whether the 2nd line treatment is complicated. He is now feeling normal and going for work. whether this 2nd line treatment makes his health normal or gives much more side effect than now. Please clarify me sir.

Response from Dr. Young

Hello and thanks for posting.

I'd ask you (and your doctor) a few questions before concluding that you need to change treatments.

First, what is your HIV viral load? Second, has there been any change in CD4 percentage? Third, are you having any new HIV symptoms or complications?

If your HIV viral load is undetectable (if the test is available where you live), especially if your CD4 percentage is increasing, then I would not advocate changing your treatment at this time. It would seem that you probably started medications with a very low CD4 count (less than your current 140); in people like you it often take longer to see the desired CD4 cell increases.

Second-line treatments, especially in developing countries, are often less well-tolerated and more inconvenient than first-line treatments. It would be helpful to know where you live and what second-line treatments your doctor is proposing.

Switching to a second-line treatment would be reasonable if there was evidence of first-line treatment failure that included new AIDS complication or intolerance, but I'm more patient (if not dubious) of the only criteria being a slow CD4 increase. Changing treatment just for lack of CD4 increase with an undetectable HIV viral load is unlikely to produce significantly greater numbers, IMO.

I hope that helps. Be well, BY



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