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Restarting Therapy
Dec 29, 2007

Dr. Daar, My new Dr. could not believe my numbers. My cd's average 1700-2000, and VL 0. So she thought I was misdiagnosed, that I never had HIV. I wanted to believe this after 11 yrs. I stopped Meds without her ok but later was told it was ok by her office. Now 6 months later after testing my numbers are VL 6960, and CD4 1271. Her office says I should start taking my old meds again (Trizivir and Viread). I'm not sure what to do, I feel like we should continue to monitor the numbers before starting meds again. And I think I should find a new DR. Help

Response from Dr. Daar

Thank you for your posting.

While it does sound like you are truly infected, the great news is that your viral load is very low and CD4 cells are high. You are clearly in a situation where being monitored off therapy is reasonable. However, there are good arguments that could be made for restarting your former regimen if it was well tolerated. In fact, at this time the field is struggling more than ever with the concept of who should and should not be treated. This is based upon the fact that the main reasons for delaying therapy have become less of an issue than in the past, in particular regimens are easier to take, more effective, better tolerated and virologic failure is typically not associated with broad cross resistance to other options. This good news is balanced by the fact that there is growing evidence that ongoing viremia may be a bad thing for the body. Current guidelines suggest that those with CD4 cells >350 cells/uL off therapy should discuss the pros and cons of therapy with an expert provider and make the best decision for themselves. Regardless of what you decide, you should do very well for a LONG time.

Best, Eric

Low CD4 cells with undetectable viral loads
Anal cancer

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