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Monitoring pcr after starting HAART?!
Nov 25, 2009

Hello, I am positive for 2 years and a half, had continuously drop in cd4 cells and started treatment 3 weeks ago with stocrin/kivexa. My cd4 were 370 and my viral load was 200.000. My doctor (who is professor of infectious diseases at University of medicine and had experience with hiv positive patients for more than 20 years) made another appointment 3 months after starting my treatment and that day they will check my pcr and cd4 counts. I am worried because I read somewhere that monitoring should be closer (2-8 weeks after beginning) but he told me that 3 months is fine, there is no reason for being worried and that is common thing here. I started treatment without resistance test (her it is done in case of virological failure) and I want to ask is it dangerous to wait so long, can I become resistant to Kivexa or other NIRT if I have resistance to Stocrine... I read something similar but can`t remember accurate point. I live in a small country in East Europe and all citizens have the same health insurance, meaning you can`t do that test earlier than 3 months... Is it worth to go abroad for that test or it is not dangerous to wait 3 months? Thank you in advance and thank you very much for all your work here, it is so helpful for all hiv positive people around the world.

Response from Dr. Henry

Good question. In an ideal world with ample resources it may be a good idea to check HIV level 4-6 weeks after starting treatment (that is my practice). Even in US $$ is getting tight so we need to be good stewards of public health dollars. The HIV RNA test is expensive (often $50- > $100) so judicious use is reasonable. Many area of the world currently never check the HIV RNA levels due to cost. Checking at 3 months is a reasonable compromise for many situations. I hope your viral load is close to or actually undetectable at 3 months (starting at 200,000 copies which is a high level if can take more than 3 months to reach detection level for some patients). Simiarly, the resistance test is expensive so is not affordable in many settings. KH



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