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When can i start HIV treatment?
Jan 4, 2008

I have been positive for 5 years now,i am yet to start treatment.My CD4 count was 147 in June,i started taking drugs to boost my immunity and it increased to 167 in October,can i continue to boost my immunity or start treatment?

Response from Dr. Sherer

I would strongly recommend that you start treatment now.

All of the HIV treatment guidelines agree that a CD4 cell count below 200 is an indication for immediate treatment. The strength of the recommendation is due to the higher risk of an opportunistic infection or other clinical illness in people with HIV infection when their CD4 cell count falls below 200 cells/ml.

The only medication that I am aware of that reliably increases CD4 cell counts is interleukin II or IL-II for short (Katlama et al AIDS. 2002 Oct 18;16(15):2027-34.). The data are solid enough for the French government to provide IL-II as part of standard HIV treatment, but this practice has not been followed widely in the United States, for several reasons. Most importantly, the increase in CD4 cells with IL-II treatment is modest at best, in the range of 30-50 CD4 cells after one year of treatment, and no clinical trial has ever been able to show that this provides a meaningful clinical benefit to patients on IL-II compared to others who did not receive it. Additionally, the duration of the increase is limited only to time on treatment, and the CD4 cell count falls to pre-treatment levels when the treatment is discontinued. And finally, there are significant side effects to IL-II that include fatigue and fever, and it is expensive.

If you are taking something other than IL-II to boost your immune system, I would suggest that you talk to your doctor about it. Many nutritional supplements claim to boost the immune system, but there is no solid evidence of any benefit.

It is also possible that the increase from 147 to 167 cells is not 'significant', i.e. that this falls within the standard error of the CD4 cell assay, and so can't be attributed to the effect of the immunity boosting medication that you are taking. You and your doctor could also check the CD4 cell percent to see if this is a real change or not. In general, the CD4 cell count has to change more than 15% to be meaningful.

I suggest you talk to your doctor ASAP about your concerns and the best ART regimen for you, as well as what you are taking for your immune system.


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