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Just admiration,ok one question
Apr 18, 2009

Dear Dr Bob,

Thanks for all the work you do here. Your answers are so eloquent and well written - and practical. Eulogy over! I have been or known to have been HIV poz for four years with a CD4 count varying between 450 and 650 over the years.I am not on meds. I have about six monthly checks for CD4 and also others for general health/cholesterol etc. I am happy with my doctor (I'm in Bangkok). He has always stated that the CD4 count is a perfectly reasonable guide to my general health. My wife who was diagnosed as positive 4 years ago and was then perilously close to death and thrived on the local cocktail, GPOvir, and has been untetectable for about three years. She has six monthly viral load checks. I often ask my doctgor whether I should have a viral load check and he says it s really unnecessary until te time comes for me to take meds. I pay for my healthcare here in cash and a viral load check is about 200 bucks. I can afford this but why waste money if it is unnecessary. I would just like to ask your opinion as to whether it would tell me anything or help me in any way regarding my health care to have a viral load done. Or should I just monitor CD4 as I have been doing. Finally, hyou may be interested to know of many of the great initiatives for HIV that are in Thailand. I am extremely happy with this, as well as having an extremely happy positive life with my lovely wife.

Positivey Positive in Thailand.

Response from Dr. Frascino

Hi Positively Positive in Thailand,

An HIV plasma viral load test may be most helpful in determining if an antiretroviral regimen is working; however, it also can provide some potentially useful information even in HIVers not yet on treatment. For instance even if your CD4 count is reasonably stable, if your viral load dramatically and suddenly skyrockets (for any of a variety of reasons, such as superinfection, concurrent STD or viral evolution), you might not want to wait a full six months to recheck your CD4 counts. This might allow you to being treatment prior to your counts dropping to a dangerous level. Consequently, while not absolutely essential for those HIVers not yet on treatment, I do find value in following periodic viral load determinations.

Dr. Bob



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