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should i start treament?
Sep 22, 2006

i tested negetive to hiv in july 06 with the viral load of 214,000 and cd 4 of 380, my latest results of september 06, i have viral load of 18,000 and cd count of 270

Response from Dr. Daar

Based upon what you have written it sounds like you underwent primary infection in July with a negative antibody test but high levels of virus. You are now 2 months further along and your viral load is in a good range and your T-cells are 270 cells/uL. The decision as to starting therapy is a complex one in your situation because it depends upon how you ask the question.

One question is whether people known to be infected for only several months derive unique benefits from the early initiation of antiretroviral therapy. Obviously the majority of infected people do not need to deal with this issue because they are not diagnosed during this very early stage of infection. At this time the unique benefits of early treatment are thought to be related to the potential to preserve parts of the immune system designed to fight HIV. In this situation the goal of treatment is to preserve these aspects of the body's immunity against HIV so that therapy can be discontinued in the future with enhanced and longer viral control. The clinical benefits from such a strategy are still being studied. Consequently, I generally counsel people about these theoretical benefits and discuss with them the usual risks of treatment, such as side effects and development of drug resistance and allow them to make the best decision for them.

Once you get beyond the question of whether you want to take advantage of the theoretical benefits associated with early therapy, then the question is when to start for everyone else with HIV infection. As you probably know this remains a controversial issue because there is no definitive data to provide the answer. In general guidelines suggest people with less than 200 T-cells or symptoms of HIV immunodeficiency should start. Those without symptoms and T-cells between 200 and 350 should consider treatment and those with more than 350 T-cells without symptoms can safely be monitored off therapy. Of course these are just guidelines and the ultimate decision needs to come from a discussion between you and your expert HIV provider. The other important thing to note is that T-cells do tend to drop off during the first months of infection and then gradually increase before leveling off. Since you have only been infected for a few months I would be reluctant to make any big decisions regarding treatment based upon your T-cells at this time since they may well end up leveling off at a higher level than they are now.

Best, Eric


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