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Starting the Fight to Keeping a Normal& Healthy Life
Sep 29, 2001

Please excuse my question if it has any redundancy to those previously answered.

I am a Africian American male living in Philadelphia. I have just recently learned that I am HIV Positive. My Delema, even thought I am educated regarding HIV and AIDS is: My physician advised me not not start any treatment, including inhibitors. The reasoning is my Viral load is 1506 copies vs. CD4 467. I first tested positive 8/31/01.

My lifestyle has not been affected nor do I feel or exhibit any symptoms, beyound swollen lymphnoids.

I am not knowledegable enough to say the doctor is wrong, but I do understand that HIV is progressive illness, and thus I feel should be weakend from the jump.

Another concern I have is the negitive reactions Africian's have to the medications used in the United States to combat HIV.

I am still vibrant, in good health. I have some problems to curtail, ie: weed smoking, cigarettes, and light drinking.

In closing, I am looking for some sound advice on how to make sure I live my normal Life without making any bad/deadly decesions on my Health, lifestyle, and treatment while I am Hiv positive. And How would I persue the HIV vaccine, and is this really a option for some one in my position. Any feed back will be greatly appreicated, and contact info for services in Philadelphia would be a blessing.

Thankyou for your attention to my requests. HIV Fighter.

Response from Dr. Aberg

Thank you for contacting us. I am glad you are learning about HIV. That is the best first step. There is so much information out there and unfortunatley there is still a lot we do not know so it can be quite overwhelming for someone who just found out they are HIV positive.

Your doctor is following the current national guidelines. In someone like yourself who does not have any symptoms of HIV, has a low viral load and a high CD4, the recommendation is not to start therapy. You need to have your CD4 and HIV voral load repeated to confirm these results. If your CD4 count remains above 350, you may not need HIV therapy for quite a while (months to years). The rationale for waiting is to avoid complications from the medicines themselves such as developemnt of viral resistance so the drugs will not work, side effects from the medications and drug interactions between the medications. Another reason is that the medicines are not easy to take and it does have an impact on the quality of your life.

A few studies suggest that as long as you start HIV therapy when your CD4 cells are greater than 200 you will do as well as someone who starts therapy when the CD4 count was >400. We do not know what the exact CD4 count should be to start HIV therapy but we do know that if we wait until your CD4 count goes below 200, your chance of living as long or as healthy is less than if you had started with a CD4 count above 200. The guidelines chose 350 because it seemed like a safe number in between 200 and 500. Remember that guidelines are just that. They are recommendations and there are always exceptions. They are not hard fast rules so some people with higher CD4 counts may start therapy if they need to or want to. Also, anyone who has ever had symptoms should be considered for therapy.

So, the decision when to start therapy is a decison between you and your doctor. It should be based on whether you have any symptoms, benefits vs the risks of the drugs, your CD4 count, possibly your HIV viral load and your willingness to start therapy. There are some centers evaluating the effectiveness of the HIV vaccine in people who are infected to see if it can boost the immune system. I would recommend that you contact the AIDS Clinical Trials Unit at University of Pennsylvania (215) 349-8092 to see if you would qualify for a trial. Even if you do not qualify or are not interested in any of the trials they are doing, they are a wealth of information. They can refer you to many of Philadelphia's excellent AIDS Service Organizations including ones that focus on HIV in African-Americans.

I wish you the best. Please browse through our many forums and ask again if you have questions. JA



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