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HIV Drug ResistanceHIV Drug Resistance
           
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New Infection
Jan 10, 2008

I tested -ve about 1-2 yrs ago, but could have been recently infected in end September 07. It probably wasn't the right thing to do, but i went for a CD4/viral load test when i had a bad flu. My CD4 was around 200, but the viral load was 30,000 copies. Is this normal? Should i start meds? Thanks.

Response from Dr. Sherer

What you should do is see a doctor and talk to him/her about these test results, confirm that you are HIV antibody positive and repeat the test results, and then come to a decision based on a viral load and CD4 cell test. There is no emergency to starting ART, it can be reasonably and effectively done over a period of weeks.

You and your doctor will also want to obtain a resistance test (if this is avilable to you and your doctor), in order to check on the possibliity that you acquired a virus with one or more resistance mutations. This will help your doctor to choose drugs that are certain to be effective against your specific virus.

If your true CD4 cell count is in the range of 200 cells/ml, also reflected by a CD4 cell percent of 14-25%, then you should start ART right away according to all international guidelines. You can talk to your doctor about your treatment options and the regimen that makes the most sense to you, as there are many fine options for initial therapy.

Your most important contribution - in addition to listening carefully and asking all of the many questions that you have - will be to faithfully take the medications exactly as described, without missing any doses or changing the doses. You will need to commit to doing this for a period of many months initially to ensure that you have gotten the best possible benefit from the medications, and in the long term you will need to have excellent adherence for many YEARS in order to get the most durable effect of the medications. By doing this, you will reduce the risk of virologic failure and drug resistance as much as possible.

As above, all of these steps will be easier when you have found a doctor to whom you can put all of your questions, and with whom you can make and implement a treatment plan that fits your needs.


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