Mar 28, 2008
In my previous question about colonoscopy, you mentioned about my cd4 and whether treatment should even be initiated with that high of a count..What are your thoughts on that?...I have always elected to treat no matter what the cd4 is and have had good luck so far....That cd4 of 766 was drawn while i was not on meds and hadn't been for 2.5 years, I had a genotype and it said that all of the drugs are still available, including the ones i'm taking (trizivir and viread). Would you offer treatment to someone with these numbers, or would you let them decide?....I've seen docs that would and seen ones that would, I was just curious about your stand on this? Thanks, Ray
Response from Dr. Henry
There is no convincing data on the subject of whether to treat with a CD4 count >> 500. The START Trial is about to begin at select sites (including in the clinic where I work) wherein treatment naive subjects with a CD4 coutn > 500 will be randomized to immediate start versus delay until CD4 count reaches 350 (current US/European treatment threshold). The moderate term risk for AIDS is very low at the high CD4 levels so much of the theoretical benefit for treatment would be related to decreasing the modestly increased risk for non-AIDS HIV-related disease (such as heart disease, cancer) . The study will need to enroll many thousands of patients who will be followed for many years to provide a firm answer (I don't know the answer so I can recommend the study to my patients since I think either option is reasonable based on our current knowledge and my own experience). KH
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