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Dr Henry, should I start treatment ?
Apr 28, 2003

Dr Henry:

I noticed that you have a large direct practice and so direct my question to you as you see results directly. I was neg last march and pos this march. My latest cd4 was 535 and vl was 324,000. I have been tokld that I am at my set point. I am asymtomatic and am a 46 year old male.

1. What are pros and cons of starting treatment now? 2. Do you think I should (if I were your patient, what would be your recommendation?) I prefer not starting yet. I appreciate any help you can give.

Response from Dr. Henry

If you are at your set point (defined as fairly stable CD4 and HIV levels over several visits) then your viral level is fairly high while your CD4 count is also high (above the level of 350 where treatment is usually recommended). The risk to get sick from AIDS over the next several years is low with a CD4 count that high but your chance to lose CD4 cells fast is high with that viral load is also high. Thus there is a good argument on either side of the should you start treatment question. If you were to start treatment you could commit to 6 months and then re-evaluate whether you want to continue as a compromise. The SMART study looks at randomizing patients like yourself to either immediate treatment or wait until CD4= 250 (again demonstrating that we really don't know what is the best thing to do). Another option is to continue watching you blood tests and if the CD4 counts drop steadily to < 400 then start treatment. KH



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