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Should I start taking medicine now?
Jul 4, 2002

Dear Dr Aberg,

I found that I was HIV positive six months ago. I went to the Doctor and he tells me that my viral load has increased to 205000 and that my T cells are at 843. He is recommending that I start a treatment due to the high viral load. I would like to have your advise please. Should I start a treatment even though my T cells are high? what are the pros and cons of starting taking medicine at this stage? Looking forward to your reply and thank you!

Response from Dr. Aberg

The question as to when to start is a good one. Many experts would recommend starting antiretroviral therapy in the setting of a high viral load regardless of the CD4 count. I usually do not unless the person is symptomatic or it is primary infection. I have a few questions. What was your HIV viral load ans CD4 count six months ago when you were diagnosed with HIV? Has this been a change? If your HIV viral load is significantly different, then we should ask why? The first thing I would do is to repeat it to see if in fact it is higher. The other information that would be helpful is whether you had acute infection when you were diagnosed six months ago? There is some evidence to suggest that starting therapy early after acquiring HIV may be helpful in retaining HIV-1 specific immunity. If it has been less than a year since you acquired HIV, then it may be helpful to start therapy. If it has been longer, it is unclear if starting therapy now will result in improved outcomes years later. There may be many long term risks associated with therapy as well as the development of drug resistance so my preference is to base my decision for therapy on the CD4 count and symptoms of the person. I usually do not begin therapy until the CD4 count is in the 300's or there is a progressive decrease in the CD4.

So, my answer depends on your situation. The first thing I would do is to repeat the HIV viral load. If it has been less than a year since you became infected, you may want to start therapy based on the risks and benefits. If you believe you were infected more than a year ago and you have no symptoms, I would follow your CD4 count and viral load to see what the trend is. I still would probably not start therapy until your CD4 count was below 500.

One of the other things to consider when one has detectable virus is the risk of you transmitting virus. The higher the viral load the higher the risk of transmitting virus. Please remember safer sex practices. Let me know what your baseline labs were and if you have an idea of when you acquired HIV. Also, let me know if you are having any symptoms associated with HIV.

Many of us will be at the World AIDS Conference in Barcelona July 6-12. I apologize in advance if I do not have access to e-mails and cannot respond until my return.



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