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IS IT TIME TO START?
Mar 27, 2010

Dear doctor, I'm brazilian 43 years olds, HIV positive since 1999 and viral load 10.200 and CD4 364. My infectologist has decided not to start The Haart Therapy and wait 2 months. In Brazil, the consense is to start the treatment about 200 CD4+. I'm cocaine adction in treatment and my doc is worried about meds and drugs. What Your opinion?

Sincerely, Walter

Response from Dr. Frascino

Hi Walter,

There are several issues to consider here. First would be how are you doing with your drug rehabilitation program. It's possible your doctor is concerned that you might fall off the wagon. Coke-heads and others addicted to illegal substances can have difficulty adhering to antiretroviral therapy dosage schedules. If adherence is not excellent, you could develop drug resistance. Antiretroviral drug resistance can make your infection much more difficult to treat. Some HIV specialists prefer to wait until the drug addiction is under control for this reason.

The other issue concerns the best time to start combination antiretroviral therapy. In general the consensus is once again swinging toward earlier intervention. As an immunologist, I can advise you that it makes excellent immunologic sense to begin treatment as soon as possible to preserve immune function and decrease immune activation. However, these beneficial immunologic effects need to be weighed against potential negative consequences, including drug side effects/toxicity, cost, need to take mediations on a regular schedule, etc.

From an immunologic perspective, I would not wait until your CD4 count falls into the 200-count range. If you feel you can adhere to your regimen and you are psychologically ready to start, talk to your HIV specialist and get started now. You can read much more about "when to start" in the archives. Take a look and consider showing some of this information to your HIV specialist.

Good luck Walter.

Dr. Bob



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