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Time to Start Treatment?
Aug 30, 2004

I had my 3 month appointment with my HIV doctor today. I was diagnosed 7/12/2002 (just after my 22nd birthday, though I know my infection date to be 4/18/2002 for certain), and have thus far avoided treatment. My CD4 % has slowly dropped from 27 to 23%, and has been hovering between 20 and 22% for the last year and a half now. My Viral load has been all over the map from as high as 287,000 to as "little as" 29,500, with absolutely no consistency between visits. My CD4 has been up and down, and for the second in a row, has been down, from 399 to 320. So, I've hit below the magic "350" threshold, and I'm now considering treatment options. The doc seems to think that since my CD4 percentage is still at 20% and my total lymphocyte was only 1600, it may not be so unusual that my CD4 absolute count would have gone down. However, I'm not so convinced. I've requested another set of labs, which I will go in for on Saturday, and if my CD4 absolute is still below 350, I want to start treatment. My question is two parts: as a doctor, would you also recommend more labs showing results below 350, and go more by the CD4%, would you have started treatment earlier, or recommend it now? Also, if I start treatment next month, what therapy would you recommend. My doctor mentioned a new combo pill of a two drug, once daily treatment, that could be taken in conjunction with Sustiva, for a 2 pill, once a day treatment. I want something powerful, yet manageable, as I fully understand the importance of adherance.

At 24yo, and postive for two years, I am hoping my numbers to rebound quickly (hopefully a CD4% up to 35-40% with CD4 absolute between 640-1100, since I started with 792.)

Sincerly, Painfully Pondering in Michigan...

Response from Dr. Conway

The right answer is...it's up to you.

As the CD4 count decreases below 350 but has not yet approached 200, we tend to individualize treatment decisions. The key is your readiness to commit to treatment, so as to maximize adherence and effectiveness, and reduce the risk of drug resistance.

Treatments can be very simple now, as little as 2 pills once a day. My best suggestion is this. Go over your lab values with your doc. If the CD4 is still below 350, go over a hypothetical regimen, and figure out hwo and when you would take it, what the short and long term side effects might be, and how taking these pills will change your life (icluding extra medical visits, etc...). If there are any issues that get raised as a result of this discussion, be reassured that it is safe for you to wait before starting therapy. If it all still sounds good, go ahead and make a plan with your doc including his/her opinion about starting (remember, this is a long term partnership, best get off on the right foot..) and proceed from there.

Good luck...



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