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When to start HAART
Aug 21, 2007

OK so here is the deal... I recently tested positive after 17 years of not being infected. My CD 4 is 520 and my other blood values are good.

I have read everything I can on starting HAART treatment, and I really can see no medical evidence not to start HAART at this point, other than concerns based on studies of adherence to taking the pills.

I believe it is my right to access the HAART now, thus increasing the likelihood of a symptom free life.

What exactly ARE the medical reasons not to start HAART?

Response from Dr. Henry

The risk for developing AIDS over a 3 year period when your CD4 count > 500 and the viral load is < 15,000 is around 2 % (98% stay AIDS free) so the actual clinical risk is low and can be monitored both clinically and by checking the CD4 count regularly. My interpretation of recent data suggests that the goal of therapy is to achieve and maintain a CD4 count > 500 so the threshold for starting therapy is likely to slide upwards as therapy becomes even simpler and better tolerated. From a population standpoint the resources don't exist even in the places like the US to actually identify all HIV + persons and treat all persons with a CD4 count < 500. In the absence of adequate resources a cost-effectiveness approach is used in order to make sure that persons who clearly need treatment can get treatment. In the current milieu I would be concerned that more widespread use of HAART in persons with high CD4 counts would result in drying up resources for persons in need. The issue is complicated since I believe that the data suggests that earlier treatment would likely be modestly better for an individual's overall health and for the public health (by decreasing further transmission). KH



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