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Starting treatment?

Aug 18, 2014

Hi, I'm a 26 years old guy, poz for 2 years. My vl has been always low ( up and down, but always under 40.000). My cd4 from 800 after conversion to 505 now (% from 23 to 21 in 3 years). I'm at the point of considering the possibility to start treatment with complera. In Italy, where i'm based, my doc told me that i'm in safe at the moment and i do not need to start. I wonder for a second opinion.. And if you recommend me to start, why? My doc told that there's the possibility for me to stay years without taking meds that, in some way, are toxic. I'm confused..

Response from Dr. Young

Hello and thanks for posting from Italy.

The current World Health Organization guidelines (a very conservative and cost-conscious group) recommends treatment for people living with HIV whose CD4 counts are below 500 (yours are close enough for this to be relevant). Increasingly, many countries around the world are embracing treatment for all- irrespective of CD4 counts. These include the United States and Brazil. If you were my patient, I'd recommend treatment. Earlier treatment has been shown to reduce risk of death, rates of complications from HIV and side effects of medications, never mind dramatically lower the risk of transmission of the virus to others. Your CD4 percentage is actually lower than expected for a CD4 count of 500 (20% normally correlates to a CD4 count of around 300)- suggesting that your immune health is more compromised than might be apparent.

WHO guidelines recommend the use of tenofovir + 3TC (or FTC) with efavirenz; here in the US, guidelines recommend 7 different regimens, 4 of which now include an integrase inhibitor instead of efavirenz.

Properly monitored, HIV medications are not toxic, and are very well tolerated. Millions of people have been on treatment for many years, and while medications continue to become safer and better tolerated, this shouldn't obscure the general benefit of treatment.

Hope that's helpful, BY



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