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My goal to reach undetectable status
Apr 28, 2008

Hello Dr. I just got my very first counts results (VL:2500, Tcells:440, CD4%:30%).Am still waiting for the genotype analysis, Once I get it my Dr and I will decide when I going to start on meds. 1) Would you recomend me to wait for a re-test in couple of month? 2) Should I start on meds right away according the genotype analysis? 3) There is A high possibility of drug resistance and I'll have to deal with limited options 4) Can I have hope of once I start on meds, and after 6 month to become undetectable with better tcell counts?...thanks in advance

Response from Dr. Sherer

Yes, I would favor option #1, to wait for a few months and repeat the tests.

The most recent HHS Guidelines advise that you and your doctor start medications when the CD4 cell count is below 350 cells/ml.

They also advise that when the CD4 cell count is 350-500 cells/ml, additional consideration be given to a high viral load (above 100,000), or to concomitant conditions like hepatitis B, TB, or pregnancy.

None of these circumstances apply to you, to my knowledge, in which case there is no compelling reason for you to start ART immediately. You and your doctor would benefit from observation of the trends in your viral load and CD4 cell count, i.e. whether they change in the next 2-3 months (or longer), and to what degree. If there is a sharp downward turn in your CD4 cell count below or near 350 cells/mm3, or if there is a sharp upward trend in your viral load near or above 100,000 c/mm3, then I would consider starting ART more strongly.

Otherwise, I would suggest that you withhold treatment and follow up closely with your doctor, reviewing your viral load and CD4 cell count every 2-3 months to detect a change in your status, if and when that occurs.

I would also ask your doctor about your belief that you are at high risk for resistant virus. You can explain why you think this is the case, and he or she can interpret the likelihood that you are correct for you.

In any case, yes, you can expect that there is an excellent chance that you will have success if and when ART is started, and that you will be able to achieve an undetectable viral load.

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