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Start Meds, or Not?
Aug 24, 2012

I have been HIV Positive for 30 years and have never been sick and have never taken any meds. In fact my last illness was the Flu in 2000. My virus was sequenced and it is one of the early varities which has no resistance to meds.

For at least the last 6 years my CD4 Count has been consistent between 325 to 350. My CD4 ratio is also consistent, though low between 0.16 to 0.22. This is because my CD8 count is very high, 1600 to 2200. This is 2 to 3 times the high end of "normal". My immune system has done very well by itself. For these 6 years my Drs have recommended that I start Atripla or Complera. I would rather not start meds, but with such a high CD8 count I'm concerned that I might burn out or impair my immunity by overuse. What do you recommend?

Response from Dr. McGowan

I am glad that you have done so well for so long. It is true that, although we are understanding more about the immune system, we do not know enough. Your high CD8s could be keeping the virus in check, but this may not last. It is clear that your immune system is out of balance and this could set you up for infection or cancer (lymphoma)...but it is hard to quantify how high that risk would be.

I would recommend treatment to see what effect it would have on your counts. The concern is that the longer the imbalance remains, the harder it may be to ultimately correct. And after 30 years, I image, you are over the age of 50 (I am part of that club as well), and our CD4 cells do not recover as well as younger folks.

Best, Joe


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