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Can I wait a little bit longer?
Aug 26, 2005

Hi,

The amount of information provided by you on this website is just incredible. I wonder if you can give some ideas regarding my situation.

I was diagnosed 6 years ago, with a CD4 count of 250. Since then the CD4 count has been between 200-350, and the viral load never higher then 5000. In particular the last 3 results were: CD4 %CD4 Viral load 20 months ago 221 13 4500 14 months ago 193 16 2150 2 months ago 245 13 1400

I am feeling fine, in good health, take multi-vitamines and sport regularly. My doctor is suggesting to start medication, or if I don't want to start, take at least Bactrim.

I am looking at it differently. I realize that my count has gone down slightly over the years, but given the slow progression, according to me I should be able to stay at least another 1.5 years without medication. Obviously I will check at least every 6 months, as I realize I need to monitor my health closely, and if the pattern changes I will have to start medication. Do you think I am being stupid here, and would you advise immediate start of the medication anyway, or do you think it is reasonable to try to prolong my life without medication as long as possible?

If I will not start any medication for now, should I start taking Bactrim, or would it be ok also to wait with this a little bit longer? My understanding is that Bactrim will just prevent the possibility of PCP, but will not do anything for my CD4 count or generic health (besides maybe some unwanted side-effects).

And another question, if I would start Bactrim, can I stop taking it anytime (for example in case, I get bad side-affects by using Bactrim) without any fear for my continuous health? As with most of the other drugs, you should adhere 99% and not stop your treatment at anytime, as this might have the opposite results, of creating resistance in your body against the drug.

Response from Dr. Luzuriaga

With a % CD4 consistently under 20%, you are at risk for Pneumocysitis and I would support your care provider's recommendation that you start Bactrim.

With regards to when to initiate therapy, it sounds as if you have not been symptomatic. Your viral load is fairly low but your CD4 counts have been quite low. I would thus recommend that you strongly consider antiretroviral therapy to prevent further deterioration of your CD4 couunts.


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