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follow up about 'changing guidelines'
Nov 15, 2008

Dear Dr Frascino,

I have just red your very informative answer to a question from a slightly hot headed visitor of this site about 'changing guidelines about whe to strat with ARV'.

I could well follow your answer. There is just one part that I did not quite understand. You said that 'data from clinical trials indicate that the risk of AIDS persists at CD4 counts greater than 500 cells/mm3'. I am currently not yet taking meds (CD4 is well over 500, Vl 16.000). Should I discuss starting meds nevertheless with my doctor? There is also another reason why I am contemplating starting ARV. In mexico City Dr Fauci has suggested that if recenty infected individuals start ARV, they could be 'functiopnally cured' in about 7 years'. What are your opinions about that?

Kind regards, Thom (Amsterdam, The Netherlands)

Response from Dr. Frascino

Hello Thom from Amsterdam,

The information supporting earlier intervention with antiretrovirals is indeed new and still evolving. Formal recommendations or further changes in the guidelines have not yet been made. (The guidelines now suggest starting therapy when the absolute CD4 count falls into the 350 range.) Additional information was presented recently at the infectious diseases meeting in Washington, D.C. That data suggested those beginning treatment in the 350-500 range showed better survival statistics than those who waited until 350.

I was in Mexico City at the International AIDS Conference when Dr. Fauci discussed his assumptions. They are indeed intriguing and caused quite a stir. An important component of his assumptions involved beginning potent effective antiretroviral therapy very, very early in the course of HIV infection.

Should you talk to your HIV specialist about beginning treatment? Absolutely. I believe a discussion about treatment options and the new and ever evolving data related to HIV pathogenesis, immune activation and optimal time to begin antiretrovirals should be an integral part of all follow-up visits for "virally enhanced" folks not yet on treatment. My personal opinion is that we will be recommending treatment earlier and earlier as time goes by!

Also Thom, continue to stay tuned to this site. The Body will continue to present the latest news, data, recommendations, guidelines, conference summaries and the occasional wise-assed answer from yours truly.

Be well.

Dr. Bob



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