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When to Start Meds
Jan 28, 2005

Dear Dr. Young,

I have been HIV+ for about 8 years, diagnosed Oct. 2004. My bloods tests have been:

Oct 04 CD4-286 VL-19600 Nov 04 CD4-315 VL-9400 Jan 05 CD4-266 VL-7870

I am 49, 5'11", 165 lbs and aside from some muscle pain in my arm, I feel in good health. I do have a skin rash from Hep A/B vaccine I just received. I am taking a regiment of daily supplements and have changed my diet to lower my colesterol. My Doctor did not recommend the supplements. I researched them on my own.

My Doctor, upon seeing my firs test results , stated that if my CD4 dropped we would start treatment immediately. Now she wants to wait two months and retest again to see if my CD4 changes. If it goes down, I will start medication, but my Doctor has not discussed what meds I should start with nor have I been tested for resistance.

The only local HIV specialist is not taking new patients and I am seeing a Doctor of Internal Medicine at a clinic.

Do you think I should seek a second opinion from an HIV specialist outside my area? I am from Santa Barbara, California (about 2 hours north of Los Angeles).

I value your option and applaud the work that you do.

Thank you so much, Joe

Response from Dr. Young

Thanks for your post.

If you were my patient, I'd be more or less in the same position as your doctor-- you're probably close to needing to start medications, but with no huge differences in your CD4 count over the past 4 months, a wait and see approach would be ok, provided that you're reluctant to start. On the other hand, with a count that on average, is below 300, if you were willing and able to be adherent, I'd be very happy to endorse starting medications now.

There are good HIV specialists in the central California coast- from Ventura through SLO-- I'd bet that if you discuss this with your AIDS Service Organization, they can give you the beta. I'd also bet that if you mentioned to the Santa Barbara (or other specialist) that you need to start on medications soon, with counts below 300, that you might get an expedited appointment.

Good luck, let us know how things turn out. From a former Californian, BY



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