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When start treatment??
Sep 16, 2012

Dear Dr. I write you from Peru. I was diagnosticated in october 2011 with 347cd4 and VL 220 000. In january my cd4 were 671 and VL 110 000. On april my cd4 were 458 and 90000 of VL. My next test would be end of august. Do you think that i need start the treatement. I will start when it will be necesary for my health, but i really dont want start yet. What do you think?

Response from Dr. Young

Hello and thanks for posting from Peru- sorry for this delayed reply.

You ask a very important question, that should start, rather than with your lab results but with your symptoms. If you're experiencing any HIV-related symptoms, such as unexplained fatigue or weight loss, then you should consider starting treatment. Here in the US, guidelines recommend starting treatment, irrespective of CD4 count or viral load for people with hepatitis virus coinfection, heart or kidney disease. Lastly, the most recent US guidelines recommend treatment to prevent HIV infection to sexual partners.

In you particular case, your viral loads would average around 150,000- pretty high, and your CD4 counts around 400. While neither places you in immediate risk of HIV or AIDS complications, the higher viral load predicts more rapid CD4 cell decline than average. Your CD4 absolute count similarly is close to international thresholds for treatment (350). Here in the US, CD4 counts are used with less frequency or importance for this decision, since treatment is recommended for all persons who are willing and able to take HIV medications.

If you're not ready to start on medications, this would still be a good time to assess all of your other health risks, such as diabetes, high blood pressure, obesity, hepatitis virus (or vaccinations), smoking, mental health, exercise habits, etc. Lastly, it's also a good time to develop and nurture a trusting and non-judgmental relationship with your health care providers.

I hope that helps. Un abrazo, BY



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