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Untreated, CD4 < 500, VL 1000-5000. What to do next?
Jun 24, 2014

Hello Dr Young. I've been infected for 7 years and am still not on meds. My VL has always been varying between 1000 and 5000 copies/mL. So has been also my CD4 count, which was ~450 near seroconversion, gone > 700 three months later (without treatment), and has been varying between 600 and 800 for the following couple years. Last 1-2 years a decrease has been to < 600 has been seen, then to 500 and then between 450 and 500 for the last couple of tests. Last lab results shown a VL of 2000 copies/mL and CD4 of 470. I don't have any special health issues, at least no more than before seroconversion. My doctor highly recommends me to begin treatment; I'm somewhat afraid, since I'm not sure this will boost my immune system (the VL is low anyway). Perhaps I should start an alternative treatment? Vitamins, diet, etc. I try to live a healthy life, but there are occasional and inevitable stresses. In any case, I'm afraid to commit to a lifetime meds treatment until I understand everything and sure it will help.

Please, I need your advice on this. Many thanks, Alex

Response from Dr. Young

Hello Alex and thanks for posting.

Current US (and other countries) HIV treatment guidelines no longer use CD4 count as a criterion for starting treatment. With your counts below 500, even the more conservative World Health Organization recommends treatment in low income countries.

Low viral loads are a good thing if you don't want to start treatment (and have a high CD4), but low viral loads can still be the cause of CD4 decline and immune system disease.

While HIV care is lifelong, HIV treatments are for the long run- this doesn't necessarily imply that you can never stop, or never miss a dose. Further, while old medications were definitely filled with side effects and sometimes caused serious toxicity, newer medications are a vast improvement, with rare side effects or toxicity.

With medications started before advanced disease, we're increasingly confident of normal life expectancy and an end to AIDS-related death. Vitamins and supplements have little, if any, impact on HIV disease progression in the developed world (it's different in places where serious malnutrition is a problem). If I were in your shoes, I'd be learning not about whether to start medications, but rather which medications are the best for me, my damn virus and my lifestyle.

Hope that helps, BY

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