Jun 30, 2004
I believe I contracted HIV in 2001, but it wasn't diagnosed until the latter part of 2003 and my question is such: When do you start taking meds? Is it when your CD4 cell count drops significantly? Right now mine(CD4 cell count) are at 345 and the viral load as well as the cholesterol level was really low. But, I have a friend, who's positive as well, and he asked his doctor to put him on meds, although he claims his numbers as far CD4 cell count was high and viral load was low. Is that possible? Or are caregivers in the business of prescribing HIV meds to a person in "seemingly" good health?
Response from Dr. Pierone
The best time to start medications is not known. We try to weigh the benefits of therapy (suppressing HIV replication and restoring immune function) against the downside (cost, side effects, risk of developing resistance). In the U.S. the typical starting point is about 350 CD4 cells. In many parts of Europe there is a tendency to start later at around 200 CD4 cells. The viral load also enters into the equation, the higher the viral load, the more likely we are to recommend treatment.
It is not unreasonable to start HIV medications at higher CD4 counts and lower viral loads. This is outside of guidelines and there are little data to support it, but there is some logic behind this approach. In short, if one starts therapy with high CD4 cells this prevents immune damage from HIV infection. After a period of time, perhaps when CD4 count goes very high (say above 800 for arguments sake), one would plan to stop therapy. Then wait until the CD4 count drops below 500 and start again with plans to treat until cells are above 800 and so forth. This strategy is very different from the current standard which is to wait until CD4 count goes below 350 and then continue medications forever. An early treatment approach does make some sense intuitively, but again we have very little data yet (mainly the BASTA study from Europe).
So when you ask the question when is it best to start therapy, also be thinking about the next natural question, when is it best to stop therapy?
Thanks for posting and best of luck.
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