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When to start meds if trying to be proactive?
Jun 25, 2012

Hello Doctor,

Thank you for the time to answer questions, this is proabably the hardest thing I have ever had to deal with and need soild advice. I was recently dianosed with HIV last week Monday. I am uncertain when I became infected but it was about 2 years since my last test. During the past 3 years I have been training my body to be very athletic, and lost some weight. When returning home from college and hearing my friends say how skinny I became I got tested and found out that I was indeed positive. I have always been a stocky guy however now I would say I am slimmer/trim. At the most I have lost 20lbs in three years.

Reciving my 1st labs back I have a cd4 count of 743 40% and a viral load of 984. My case worker said these are "good numbers". My concern is when should I start medication? I do not want more damage done to my immune system, yet I keep hearing so many negative things about medience. I also have diabetes and do not want my diabetes to suffer from taking meds. Are there any studies that show early medication benefical? Also without meds won't my viral load just keep rising? And also what if I just became infected wouldn't my viral load be low? I am just asking for more informtation on WHEN I should start treatment. I love my life and want to be alive for as long as God see's fit. But I don't want to be in a situation where I am wishing I would have started meds sooner. Thank you for your time.


Response from Dr. Young

Hello and thanks for posting.

With your apparently unexplained weight loss, we might conclude that even with "good" CD4 count results that you have symptomatic HIV infection and as such might benefit from starting treatment. The decision to start is an important one that should take into consideration a number of factors. One of the most credible sources of information about antiretroviral treatment is the US Department of Health and Human Services Guidelines. The 2012 Guidelines suggest treatment for nearly all persons living with HIV, irrespective of CD4 count or viral load, provided that they are willing and able to commit to taking medications. The Panel's recommendations are listed below (the letters and numbers refer to the strength of the data or recommendation, AI is the highest).

* ART is recommended for all HIV-infected individuals. The strength of this recommendationa varies on the basis of pretreatment CD4 cell count: CD4 count <350 cells/mm3 (AI) CD4 count 350 to 500 cells/mm3 (AII) CD4 count >500 cells/mm3 (BIII)

* Regardless of CD4 count, initiation of ART is strongly recommended for individuals with the following conditions: Pregnancy (AI) (see perinatal guidelines for more detailed discussion) History of an AIDS-defining illness (AI) HIV-associated nephropathy (HIVAN) (AII) HIV/hepatitis B virus (HBV) coinfection (AII)

* Effective ART also has been shown to prevent transmission of HIV from an infected individual to a sexual partner. Therefore, ART should be offered to patients who are at risk of transmitting HIV to sexual partners (AI [heterosexuals] or AIII [other transmission risk groups]).

* Patients starting ART should be willing and able to commit to treatment and should understand the benefits and risks of therapy and the importance of adherence (AIII). Patients may choose to postpone therapy, and providers, on a case-by-case basis, may elect to defer therapy on the basis of clinical and/or psychosocial factors.

For more information about starting HIV medications, check out's Resource Center on Starting HIV Treatment.

Be well, BY

changing meds
Just diagnosed with kaposis and HIV neg 3 months ago

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