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Starting meds
Nov 4, 2013

Dr. Young, I wrote you in October about starting meds and viral load. My viral load dropped from 400,000 to 120,000 in a month. My CD count rose from 600 to 650. My doctor says, based on the viral load I should start meds and not wait until the CD count drops. Is there a downside to starting meds now? She says no, unless I stop taking them which I'm not planning on.

My Dr. says I should take 4 at once, tenofovir, emtricitabine, ritonavir, and darunavir. Is this a good combo for someone newly diagnosed without having taken meds before?

Thank you for your time!

At what viral load level should one start meds? Oct 10, 2013 I tested positive in August with a viral load of 1.5 million, which dropped in September to 400,000. My doctor wants to see what the viral load is in October before discussing medications, she says it should drop more. Is there a recommended viral level to start meds?

Response from Dr. Young

Hello and thanks for posting.

We generally don't use VL tests as an indicator for when to start medications, though someone with a very high viral load (both of yours qualify), the risk of disease progression while waiting to start is considerably higher (independent of CD4 count).

That said, in the US, treatment guidelines recommend that treatment be started independent of CD4 count. Elsewhere, the World Health Organization (no early start group, by any means) now recommend treatment for all HIV+ people with CD4s less than 500 who are willing to be on medications.

I hope that helps, BY

Response from Dr. Young

Hello and thanks for posting.

For several years now, US treatment guidelines recommend starting HIV therapy for all people who are willing and able to be adherent to medications. This recommendation is even stronger for those people whose viral loads are high (greater than 100,000). There's strong evidence that starting sooner results in lower risk of death, AIDS and non-AIDS complications as well as lower risk of drug toxicity and side effects.

So, I'm in agreement with your doctor- the regimen that she's recommended is one that is among several "preferred" regimens in current guidelines.

Hope that helps, BY

What is viral load undetectable?
Smoking tobacco while on Kaletra and Truvada

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