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Off medication for 6 yrs.
May 16, 2012

I started my meds in 1999. In 2004 I had my lg. intestine removed. In 2006 gall bladder removed. While I was in the hosp. My docs took me off my hiv meds. I go every 3mos for blood work, yesterday found the results to be upsetting. over 1000copies for viral load and my cd4 was 534. This is the first time it has been this low, usually it is around 700. I have been stressing about a job unemployed since 12/11. I have found one and will start next week. I am looking forward to it but, I am so tired. Am I an experiment my doc is doing or do you think I should be back on the meds. And will it make me feel better.

Response from Dr. Young

Hi and thanks for posting.

I wouldn't think of your HIV care as an experiment- there's a lot of very evidence-based strategies and treatment guidelines.

I might suggest that you could be over stressing about your most recent test- any single test should be seen in the larger context of all your previous tests and with the understanding that there is quite a bit of variability in tests. Indeed, while your current CD4 test says an absolute value of 534, it wouldn't surprise me if a repeat showed the value to be back to the more typical range. Indeed, whenever I'm faced with this question, the very first thing I do is to compare the CD4 percentage values between the tests- often the value hasn't changed significantly, and if so, I tend to discount (or not stress) about the absolute value.

Now, you say that you've been off HIV meds since 2006. If you've been doing- and feeling well, there's no hurry to go back on the medications. On the other hand, there is a growing trend in recommendations, especially among older individuals (over ~50) to recommend treatment, independent of CD4s. Treatment interruptions are no longer in vogue and there are very strong evidence that medications dramatically reduces the risk of transmission of HIV to sexual partners. Medication options today are also increasingly better tolerated and easier to take (certainly compared to 1999).

So I hope those words (and your new job) are helpful in relieving some of the stress. Feel free to write back here anytime.

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