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Should I start meds? Am I a long term non progressor?

Dec 2, 2014

I am a 40 year old male who doesnt want to be on drugs all my life. I hope I am not making excuses. I was diagnosed in 2004 and my CD was around 326, vl 7000 and percentage about 23. My numbers continued to go up but never fluctuated very badly and has never gone below 326. At one stage it went to 700. VL dropped to 5000 and later to 2000 and now to 1,200 in March 2014 with CD being 490 and percentage 28.6. The doctor under whose care I am feels I am doing very well, including being asymtopmatic; however, one of the doctors with wom I am still in touch from I was diagnozed and who lives in another country feels I should be on medication right away. He keeps saying that despite my relatively good numbers. I like my primary doctor. I am not ready to start meds and even though my numbers not 700 or slightly below 500 am I being naive? Should I start meds? Could I be a long term non progressor. All I have are lymph nodes.

Response from Dr. Young

Hello and thanks for posting.

If you're viral load is above 1000 (on average), it's unlikely that you're a non-progressor; slow perhaps, but not a non-progressor. If you have swollen lymph nodes, that already raises some concern to this doctor. Sorry.

There is considerable opinion and recommendation that suggests treatment for most patients who are willing to take and be adherent to medications. While that might not be you, right now, if you were my patient, it would be my recommendation.

Nobody wants to take medications, and that's understandable.

At a minimum, careful ongoing monitoring of your health, CD4 numbers (look at trends in absolute and percentages)- many of the patients that I've taken care of who had similar profiles eventually progressed, with declining CD4s and increasing VLs.

And HIV disease risk isn't only about your CD4 count, it's about chronic inflammation and risks of cancers (which don't always correlate with CD4s) and the risk of transmission to others (among other things too). New HIV regimens are extremely well tolerated, safe and don't generally interfere with your daily activities. With them, normal life span is now expected. But delayed initiation of treatment is associated with years of life lost. I'd hate for you to fall into this category.

I hope that helps, and feel free to write back. BY



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