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Should I begin Treatment?
Jan 30, 2003

I tested HIV+ in October. The last time I was tested was about six years ago when I was still negative. I believe I got the virus one to three years ago. My VL in October was at 39.000; my CD4 count was 370, and at 24. My doctor said I was borderline for beginning treatment and we decided to wait for my next test. Mid-January my VL had gone down to 20,000. My CD4 count went down to 322, and 17. This seems like a big drop for a three month period, especially in the percentage figure which, as I understand it, tends to be a much more stable indicator. My CD8 count went up a lot, but the importance of this number seems to be a mystery. My doctor feels I should now begin treatment. I am otherwise healthy. A friend of mine who has been HIV+ and went off treatment eight years ago (successfully) says I should wait for at least one more test, maybe in two months. Any thoughts?

Response from Dr. Young

There's unlikely to be a right or a wrong answer here- I'd think that starting therapy in the near- to intermediate-term future is probably a good idea, though waiting for a repeat test to be sure would be fine, so long as you don't have active symptoms, like fatigue, wieght loss or active infections.

What all this means, is that the lab tests are just one part of a very complex and individual set of factors that determine when the best time to start therapy is-- if everything else is ok- like your social and mental health, ability to adhere to medications, and so on, then I usually would suggest starting. Conversely, if these other issues are out of balance, then waiting (or initiating corrective measures) is ok too.

So much of the decision to defer initiation has to deal with the risk that medications will cause side effects-- recent data actually suggests that for some significant side effects, like lipodystrophy, the risk of occurence actually increases as one's CD4 cells decline. Moreover, data from the HOPS study (see conference coverage at TheBody) suggests that the risk of developing lipodystrophy is influenced, not by one's current CD4 cell count, but one's lowest ever CD4. This would mean that waiting too long would irreversibly increase the risk of this, and possibly other complications.

Hope this is helpful.-BY



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