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Begin Treatment?
Mar 10, 2008

My doc and I were talking. I have a viral load of 42,000 and T-cell of 827. My infection was from June/ July. I PEP'd and got a neg viral RNA in late Aug. in late Jan, I tested +. I want to start treatment to knock the viral load down. Is it appropriate to start now with just a protease inhibitor? Thank you Dr. Frascino.

Response from Dr. Frascino

Hello,

Sorry, but your history is a bit too sketchy for me to figure out exactly what transpired and consequently I'm reluctant to provide very specific recommendations. I will make some more general comments that I hope will be useful to you.

I'm assuming you were exposed in June/July and then took PEP. Post-exposure prophylaxis for HIV should be started as soon as possible and no later than 72 hours after exposure. Did you begin PEP within that timeframe? Next, PEP consists of a combination of antiretroviral drugs. Consequently a negative PCR RNA would be expected if taken while you were on PEP, assuming the combination of antiretrovirals was potent and effective. (This is why PCR RNA testing is particularly unwarranted for HIV diagnosis while on PEP.)

Presently your absolute CD4 count is 827 and HIV plasma viral load is 42, 000. The current treatment guidelines would recommend you consider beginning treatment when your CD4 count drops to 350 or less unless there are extenuating circumstances. When and if you begin treatment, starting with "just a protease inhibitor" is definitely not a good idea. Single-drug therapy often quickly leads to drug resistance. When therapy is started, a combination of two nucleoside reverse transcriptase inhibitors plus either a non-nucleoside reverse transcriptase inhibitor or protease inhibitor would be recommended. Your HIV specialist will be able to identify your best treatment options based on your initial HIV resistance test results. You can learn much more about beginning HIV treatment and a host of other HIV-related topics by reviewing the wealth of information on this site. I'd suggest beginning with the "Just Diagnosed" and "HIV Treatment" chapters that can be easily accessed on The Body's homepage under Quick Links.

Good luck.

Dr. Bob



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