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Stoping treatment
Nov 18, 2006

Hi, I am a 28 yo male. I started treatment about 3 years ago, my CD4 were 165.I took Sustiva and Combivir.I stopped medication 2 months ago. My VL was undetectable and my CD4 was 362. Never had really bad side effects except for some dizziness sometimes after taking Sustiva on empty stomach.I starting doing some research about the toxicity of the meds i was on and got worried. I decided to take a brake and see what happened. This was almost 2 months ago. I have a very healthy diet and do excersice regularly, no alcohol or drogs, Almost never eat white sugar, sodas or processed food.Eat little meat, pretty much a sea food vegetarian in fact. Did my first tests last week and they came out unfavourable. CD4 108 and VL 169000. Got a bit worried, but somehow get confused, because i don't have any symptoms of weak inmune system like i had before starting treatment 3 years ago. I haven't had a cold in many months, I have lots of energy, no fevers or sweats, same weight for years, Sleep like a rock. Can all these sympstoms come all of a sudden all together? I have heard of different tests and varying results of VL and CD4 count, so i don't know if i should go bacck to meds right now or wait some time and do anotehr test?

I get my treatment from the Gov. my doctor is very closed to alternative treatments or anything that is not pills, so i want a differnt opinion. Thank you very much for your time. Nicolas

Response from Dr. Daar

Hi Nicolas, Thank you for your post.

Having a CD4 cell count of less than 200 cells certainly suggests that one is at risk for developing complications of HIV and AIDS. This doesn't mean that symptoms would be apparent right away, just that they can develop. Unfortunately it is difficult to predict when symptoms might develop in any given individual. It is for this reason that we generally recommend treatment before people drop to less than 200 CD4 cells/uL so as to avoid the development of complicaitons which can be severe.

In someone who starts therapy with less than 200 CD4 cells, then experiences an increase in cells and then stops treatment, experience is that CD4 cell do generally decline to where they were in the past, if not lower. In your case it would not be unreasonable to repeat blood work; however, based upon your previous CD4 cells I suspect you will need to reinitiate therapy. Don't be fooled by the fact that you feel well into believing that you are not at risk for something bad happending. I would suggest you go back and disuss various treatment options with your provider so you can start thinking about what to do next.

I hope that helps. Best, Eric

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