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When to start meds -- very low initial viral load test

Jul 30, 2009

I'm recently diagnosed and suspect I was infected about 12 months ago. Based on what I've read on your site and elsewhere, it seems like there's more and more evidence that one should start anti-retrovirals earlier than the current guidelines suggest. In my case, my CD4 count is 478, CD8 is 808 for a CD4/CD8 ratio of .59. But my viral load by PCR is just 1320 (log10 3.121). Would you still lean toward starting treatment soon even if my viral load stays more or less this low?

Response from Dr. Frascino


The optimum time to begin combination antiretroviral therapy remains a topic of hot debate. Yes, recent clinical trials' data suggests starting earlier has potential benefits on morbidity and mortality. As an immunologist I can advise you there is strong evidence that starting earlier preserves immune function and decreases immune activation. As for whether you should start, that depends on many factors, including whether you are motivated to begin. The potential benefits of starting treatment early need to be weighed against the potential risks of taking antiretrovirals (short- and long-term side effects, toxicities, drug interactions, etc.). I suggest you discuss this thoroughly with your HIV specialist.

Good luck! Be well.

Dr. Bob

PrEP trials
WIF needs ur opinion ! plzzzz answer doc !

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