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Managing Side Effects of HIV TreatmentManaging Side Effects of HIV Treatment
          
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When to start treatment
May 5, 2010

I really need to decide. I was diagnosed HIV+ 4 weeks ago. Right now my CD4 is 406 and my Viral Load is 37000 copies. One doctor already prescribed Combivir (every 12 hrs) and Stocrin(Efavirenz) 600 tab (every 24 hrs). My question is, should I wait to start taking the medecines and do a regular checks every 3 months or should I start right away taking the pills. I have heard people been stable for many years before start taking the pill. I feel very good. I eat well and excerciese everyday. Thanks

Response from Dr. Henry

In the US it is now recommended to start HIV treatment before the CD4 count falls < 350 (new guidelines recommend treatment when < 500 with stronger recommendation when < 350) due to protection against AIDS and other health threats that may be linked to HIV infection(heart disease and cancer for example). The overall risk for side effects and resistance is lower when starting treatment at higher CD4 counts. The chances to obtain a high CD4 count on treatment are greater the higher the CD4 count is when starting treatment. Also, being on effective HIV treatment lessens the risk for transmission to another person. Ultimately, the patient needs to be committed to treatment. If there are other social (housing), medical (drug use, mental health issues, other untreated problems such as high blood pressure or diabetes) then sometimes reasonable to prioritize the problems with HIV sometimes being down the list of concerns for the patient in which case waiting until overall health/situation is better may be prudent. KH



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