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Managing Side Effects of HIV TreatmentManaging Side Effects of HIV Treatment
           
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aluvia and kaletra given by doctor
May 16, 2012

Hi doctor, my partner just got his second cd count today it changed from 629 to 653 and he does not have viral load results yet. here in nicaragua they give us the test every three months and the results one and two months later. my name is wilmer. my partners doctor asked him to begin treatment with kaletra (lopinavir and ritonavir) and EMTRICITABINE/FUMARATE TENOFOVIR DISOPROXIL COMPRIMES 200MG/300MG today... he has some questions... how recomended is to begin treatment with the cd count that got higher than the previously one test... they told him that the public health is having some problems and they want to make sure he begins his treatment but we all know that this is a lifetime treatment once we decide to begin with we must not stop... he wants to know what can he expect on the viral load results for his second test ... he is worried because his next medical appointment is in november... next appointment is june 8th just to receive the medicines... they give us the medicine for one month at the beginning and one we show adherence they give it for two month... what is your advice for him... is it really necessary or advisible to begin treatment right now... thank you very much doctor again for your valuable help what should he do now... doctor... Can we expect side effects with cd count of 659...

Response from Dr. Henry

The risk for development of AIDS is low with a CD4 count > 500 though there may be increased risk for non-AIDS HIV related conditions (ie cancer or heart disease-that risk still being evaluated) and risk for transmission is decreased if on effective HIV treatment. Those observations have resulted in new US treatment guidelines recommending starting antiretroviral therapy evenif CD4 count > 500 if patient is willing and resources allow. The evidence for that is still modest with some key studies underway that should provide guidance in the future (most notably the START study). The recommended regimen is generally a good one. The CD4 count varies from day to day particularly when high so hard to make much out of changes from one test to another in many situations. Viral load tends to stabilize 6 months after initial infection but usuaully would decrease dramatically after ART started. Treatment is a long term proposition so the patient should be committed to it before starting. KH



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