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"Long - termer" starting meds
Nov 5, 2012

Hi Dr McGowan, I will be starting Complera in 1 week and have been pos. since Jan 2000. Latest bloods: CD4 >600 VL 28K. I have done my best to stay well and off meds. for as long as possible, but have prepared for commencing meds. due to low neutrophil levels (<1.5 for over 2 years, now at 0.9 for 3 months). I have never felt physically unwell from HIV and rarely get sick from common flu etc..I do however struggle with fatigue, more recently. My Q's: With new opinions and facts about earlier(with newly diagnosed) treatment, do i still have the same outlook as someone who has been treated earlier than myself?...and although my resistance test was reactive to all meds., will they be as effective for someone like me (untreated for 12 years) My bone marrow has been tested and lymph node biopsy has been done, and there is no Lymphoma. Is the neutropenia therefore a result of HIV?...and can I expect my neutrophil levels to improve with treatment? I am 38 and have always had CD4 <600. Thank you for your time and help.

Response from Dr. McGowan

Thank you for your post.

It is always important to balance the pro and con of taking treatment.

Starting meds after 12+ years of infection should not impact on the success of the meds to get your virus to undetectable (especially since your virus has no resistance mutations). Since you are "ready" to take meds, in fact, it may improve your chances because now you can truly commit to treatment and the combo is easy to take.

So, the meds should work to get the virus undetectable. The next question is, will your immune system recover? Studies show that starting with higher CD4 count (> 350 or 500) will lead to higher counts over time on therapy. So if a person starts meds with 100 CD4 cells, they may increase by 200 to 300 cells over several years and end up in teh 300-400 range. If you start at 600+ and increase by 200 to 300 you will end up in the 8-900+ range...which may be better.

Age is also important. Starting meds before age 50 gives a better chance of building up the immune system than older ages.

As far as the neutrophil counts, HIV has been associated as a cause of low white blood cell (and neutrophil counts), although this is less common than other blood abnormalities (such as anemia or low platlets). So, there is a chance that your neutrophils may improve, but I don't think anyone can guarantee. If you can maintain a neutrophil count over 1,000 that may be adequate.

Best, Joe

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