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venezuela is different
Jun 12, 2008

dear Doc, I hope you are doing fine. You answered me some weeks ago about when to start treatment. YOu must know vnezuelan doctor agreed to start treatment only when CD4 count is 250. My question is as foolows, Iy you were me and you had the money to do so would you travel to USA to get the treatment?. Notice that venezuelan legislation prohibits free sale of ART. My boyfriends CD4 count dropped to 350. What should I do?

Response from Dr. Frascino

Hello,

Until relatively recently the guidelines in the U.S. and Europe recommended beginning antiretroviral therapy when the CD4 count dropped to 250. The most recent revision of the treatment guidelines now recommends starting HAART at 350. I agree with these recommendations and in fact often recommend starting therapy even earlier to preserve immune function and decrease immune activation.

Your situation poses a problem, because even if you did come to the U.S. to obtain a supply of antiretroviral medications for your boyfriend, he would still need ongoing follow-up laboratory tests and to be monitored for side effects/toxicities. More than likely antiretroviral medications will decrease his plasma HIV viral load and increase his CD4 count. This will put him even farther away from the 250 cutoff where he will qualify for antiretrovirals under Venezuela's current drug plan. Consequently, you would need to continue getting his antiretrovirals in the U.S. This will most likely eventually become cost prohibitive. Consequently, at this point your options appear to be limited. Although we now recommend starting earlier than a CD4 of 250, following your boyfriend's counts closely while waiting for him to "qualify" for the drug program may well be your only reasonable option at this time. I would not anticipate he would have any significant medical consequences (such as opportunistic infections) from waiting to begin treatment at a CD4 of 250.

Good luck to you both!

Dr. Bob



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