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should I wait before starting ART?
Jan 13, 2017

Doctor, I was diagnosed HIV+ on Nov 2 by chance (I got syphilis in fact). In 2 months they measure my viral load 3 times, and it's stable 2700 copies/ml, sensitive genotype. CD4 were 275/14%; 375/23% and 312/18% respectively. I have no symptoms apart from fatigues (since a few years though). My Dr advises me starting Triumeq ASAP, just waiting my HLA test confirmation. Is it so urgent after all, considering I probably have this since a few years and I feel all right? ART risks/benefits are still not so evident, new better thérapies are likely to arise soon, so: do you consider my lab results really grant a rapid ART start please?

Response from Dr. Young

Hello and thanks for posting.

Sorry about your recent HIV diagnosis, but it's indeed a good thing that you know your status (a significant number of people don't), have access to care (a significant number of people don't) and a doctor who is aware of the current World Health Organization (and US and other national) HIV treatment guidelines that recommend initiation of treatment irrespective of one's CD4 count or symptoms (a majority of countries around the world still haven't adopted the 2015 recommendations).

So, I'm in complete agreement with your doctor's recommendation to start treatment as soon as your ready, and with the use of Triumeq (abacavir/lamivudine/dolutegravir).

HIV treatment has been shown in multiple large, randomized clinical trials to have health benefits for people living with HIV (lower rates of serious infections, cancers and death) when started, even when one has a normal CD4 cell count and no symptoms (but you already have fatigue). Your counts are below normal, so one can safely estimate that your risk/benefit ratio is even further in support of treatment. Moreover, it's absolutely clear that when one's HIV viral load reaches undetectable levels, your risk of transmitting the virus to others is essentially zero (undetectable=uninfectious).

As for current versus future medications, Triumeq represents the next generation of HIV treatments- those based not on protease- or non-nucleoside inhibitors, but rather on integrase inhibitors (in this case, dolutegravir). Indeed, in separate clinical trials for initial treatment, dolutegravir was shown to be superior to regimens that contained the once-standard efavirenz (part of Atripla) and the protease inhibitor darunavir (Prezista, part of Prezcobix).

I hope that this is helpful, BY

Help with Syphilis
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