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Only high viral load should I start treatment? part 2

Mar 9, 2002

Hello, I wrote back in July about having high viral load with little to no symptoms and high 400 T-cell counts. I have been monitoring them and 6 month later my viral load is still higher 359,000 BUT my T-cell is going up too - 497. I would still like to "wait and see" with quarterly monitoring. Do you think this is a reasonable course of action? Thanks, Ken

Old message below.

Hello, I have been positive for 15 years and haven't taken any antiviral. T count is steady in the high 400 range. No infections - my doctor says I'm in great health. BUT my viral load is 344,000 - having climbed over the last 6 months. My doctor wants me to start treatment but I don't feel ready to commit to a lifetime of taking drugs. If I monitor my health and t-cells regularly, do I really have to start treatment? Thanks for your help. Ken

Response from Dr. Aberg

I am surprised that you haven't started to see a drop in your CD4 count. Although your count is 497, do you know what the percent is? There is a lot of controversy about when to start antiretroviral therapy (ART). According to the US guidelines, most would recommend that you start ART. But remember these are just guidelines and every decision has to be based on the individual. Do you have any signs or symptoms associated with HIV? I think if you really are not ready to start plus you do not have any symptoms plus your CD4 count is >20%, then I would be continue to monitor you closely. But again, that is very controversial and other experts would say that we know the higher the viral load that the more likely you are to develop complications such as infections. It also means that you are more likely to transmit the virus to a unprotected sexual partner so some would argue from a public health standpoint you should be on ART.

I do not think there is a right or wrong decision. I am realy curious about your CD4 percent. I also would like to know the fitness of your virus but that is an investigational assay. Another question for me is whether you acquired a virus with multiple mutations which may be associated with a virus that isn't as highly infectious to your body. This gets complicated and we still do not have enough information about the infectivity of these viruses.

So, get back to me about your CD4 percent and what your decision is.

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