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Rising T-cells, why start treatment?
Aug 26, 2007

Doctor, My T-cell count keeps rising from 403 to 420 to 450 and my viral load jumps around A LOT. From 150K to 56K to 160K. I have not had any major infections. Despite my rising T-cell count, my doctor keeps telling me that I should be on treatment w/in a year. If my t-cells are going up, what is HIV doing to me such that I should go on treatment?

Response from Dr. Frascino

Hi,

There is ongoing discussion as to when the best time is to begin HAART (highly active antiretroviral therapy) for HIVers. The guidelines continue to evolve, as newer, less toxic and more effective anti-HIV medications are developed. Ideally, for any serious progressive infectious disease, we would like to begin effective nontoxic treatment as soon as the infection is recognized and the diagnosis established. The reason we haven't done that with HIV is that our treatments to date are not curative and have significant short- and long-term side effects and toxicities. Consequently we have been trying to balance the benefits of beginning life-long treatment against the risks associated with the long term use of these medications. The pendulum has swung back and forth over the 26 years of the epidemic from "Hit Early, Hit Hard" to "Hit Wisely." Currently the treatment pendulum is once again swinging in the direction of hitting earlier. Over recent years, guidelines were recommending treatment be started when the CD4 count approached 200-250. Recent data is now suggesting that we should consider beginning treatment earlier. 350? 500? Even sooner? Ultimately we will get to the point where treatment will be started as soon as the diagnosis is made. Although, I don't think we are there yet.

So what should you do? Talk to your HIV specialist. Even get a second opinion regarding when to begin treatment from another HIV specialist, if you are uncomfortable with your doctor's recommendation. Also, review the recent information on this site from the International AIDS Society (IAS) meeting, which was recently held in Sydney. There was a good deal of discussion there about moving up the start time in the "when to begin treatment" guidelines. Stay tuned to The Body. We'll keep you posted on evolving treatment recommendations.

Let's all be here for the cure, eh?

Dr. Bob



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