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First Viral Load Question
Dec 9, 2007

I read in another answer that you start ART when someone reaches above 100,000 in their viral load. I got my first set of blood work back a few weeks ago and the VL was 118,000. I go back in 3 weeks to get a second set of tests. Should I begin researching meds now? Is 118000 at this point (being infected in May) an indicator that I need to start meds?

Response from Dr. Sherer

The HHS Guidelines were just updated on Dec 1, 2007, and they advise that everyone who is asymptomatic with a CD4 count of 350 cells/ml or below should be on antiretroviral therapy (ART) (see link below). It also notes that when the CD4 cell count is 350-500 cells/ml, consideration should also be given to the viral load, and a viral load above 100,000 copies/ml, as you suggest, is associated with a greater risk of disease progression and is an additional consideration to start ART.

In your case, you did not mention your CD4 cell count, so I would suggest that you return for your second viral load and CD4 cell count, and, with the results in hand, that you discuss your treatment options with your physician. You are most welcome to take your question here and my response to that discussion as well.

You and your doctor will also talk about a number of other issues. These include the results of your resistance test, your current signs and symptoms of HIV disease (if any), other medical conditions that you have such as hepatitis B/C, TB, heart or kidney disease (if any), other medications that you are currently taking (also if any), and other important information. If your are female, your doctor will also ask and counsel you about past and future reproductive issues. Your doctor will also remind you about HIV prevention, and offer further counseling on the best way for your to prevent further transmission. And your doctor may also have advise on various other aspects of HIV, such as disclosure of your status to family and friends, and assistance with such issues as housing and entitlements that, if not addressed, may interfere with a healthy response to treatment.


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