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Managing Side Effects of HIV TreatmentManaging Side Effects of HIV Treatment
          
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Pros and Cons of starting treatment with high CD4 count
Sep 29, 2004

I started treatment with a fairly high CD4 count (640), but my viral load was 500,000. My doctor said it was up to me, if I wanted to begin treatment. As a 44 year old man, I decided I'd rather not risk losing too many of my T-cells, as I've heard they're harder to come back in older men. I'm currently on Sustiva and Truvada (switched from Combivir two weeks ago due to bad reaction) and seem to be doing well. I just had blood work done, last week, and haven't had the results come back, yet. My question is; was I right to go ahead and start treatment with such a high CD4 count? I'd love to hear what the pros and cons of beginning treatment with my numbers are. Thank you for this wonderful service!

Response from Dr. Henry

Good question for which there is no right answer and a need for more data. My recommendations often depend on many factors which are highly individualized. A good discussion about the pros and cons of starting treatment early can be found at the website www.aidsinfo.nih.gov under the treatment recommendations tab (recommendations for treatment of adults and adolescents). A persistently high viral load often predicts a faster rate of decline for the CD4 count. Often the viral load will come down over the first several months of infection--if it doesn't (i.e. remains > 100,000) I am more likely to recommend treatment even in the setting of a higher CD4 count. Side effects, the chance for development of resistance, the committment level of the patient to high levels of adherence, active chemical dependency problems and many other factors go into an individualized recommendation. KH



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