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Health provider won't put me on meds
Nov 6, 2013

Dear Nelson: I have been positive for a year now.(I know when I got infected as I know who gave it to me and how). I live in Spain and my healthcare provider keeps track of my infection not as closely as I would like. He checks on me every 6 months now after my last labs (June 2013), which showed VL 36000 and CD4 1300. I presume that my immune system is doing ok, but VL constantly rises (x5 in a periodo of 4 months). I'm concerned that the more I remain untreated, the virus will invade every reservoir possible. Would you recommend immediate treatment, even though my CD4 count is even better than that of many negative people? I feel that the public healthcare system in my country holds back any early treatment. There have been major budget cuts and this affects all patients, I include myself here. Many thanks for your response

Response from Mr. Vergel

People without insurance that get care in government funded clinics are having a difficult time getting treatment when their CD4 levels are like yours even though the DHHS guidelines for the treatment of adults with HIV recommend treatment for all people diagnosed with HIV. Some countries do not treat until CD4 cells drop to 500 cells/ml or even 350 cells/ml. The World Health Organization has the following guidelines:

Topic and population: When to start ART in adults and adolescents

Recommendations:

As a priority, ART should be initiated in all individuals with severe or advanced HIV clinical disease (WHO clinical stage 3 or 4) and individuals with CD4 count ≤350 cells/mm3 (strong recommendation, moderate-quality evidence).

ART should be initiated in all individuals with HIV with CD4 count >350 cells/mmsup>3 and ≤ 500 cells/mmsup>3 regardless of WHO clinical stage (strong recommendation, moderate-quality evidence).

ART should be initiated in all individuals with HIV regardless of WHO clinical stage or CD4 cell count in the following situations:

Individuals with HIV and active TB disease (strong recommendation, low-quality evidence).

Individuals coinfected with HIV and HBV with evidence of severe chronic liver disease (strong recommendation, low-quality evidence).

Partners with HIV in serodiscordant couples should be offered ART to reduce HIV transmission to uninfected partners (strong recommendation, high-quality evidence).

****

I do not know how to suggest to you to start treatment if you have to pay cash for medications. The cheapest regimen costs around 22,000 dollars per year in the United States. Do you have a partner who is HIV negative? May be this will qualify you for treatment if your country follows WHO guidelines.

Good luck and stay healthy

Nelson Vergel



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