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What Questions Should I ask?
Jul 31, 2001

Hi-

I was diagnosed HIV+ just last week, Tuesday, July 17th. Aside from being positive, the doctor said I am in perfect health, but we need to set up an appointment in the coming week to do blood tests, which will help indicate where I am exactly. My appointment is scheduled for Tuesday, July 24th.

I have to admit I am a bit anxious. I am hoping you can help. I would like to know what questions I should ask about treatment. What medicines are the best in preventing the virus from progressing? Any information you can provide will be helpful.

Thank you,

Anonymous, NYC

Response from Dr. Aberg

The first visit is always difficult because it is so overwhelming. The most important issue is accepting that you have HIV. I encourage you to get involved with a support group and if available, a peer advocate. A peer advocate is someone who has HIV and can help you learn about HIV.

Do you need therapy or not? That is the question you want to ask your doctor. What is your T-cell count (also called CD4 cells)? These are the cells that fight infection and the cells that HIV destroys. You also want to know what is your viral load (amount of virus in your blood).

Some people find it helpful to envision a train on the tracks coming to a deadend. You don't want to come to the deadend. The CD4 count is the distance the train is from the end. And the viral load is how fast the train is approaching the end of the tracks. The higher your CD4 count is, the farther you are away from the end of the tracks.The lower the viral load is then the slower the train is approaching the end of the tracks. HIV medicines called antiretroviral medication can make your CD4 cells go higher and the viral load very low to undetectable. So in essence, the medicines can halt the train and push it backwards! The medicines won't cure HIV but they certainly have helped people with HIV live longer and have less infections.

But the first questions you want to ask are what is my CD4 and what is my viral load? Although everyone is different and we choose therapy based on multiple factors, the guidelines suggest that if your CD4 is less than 350 cells or your viral load is greater than 55,000 you should start therapy. Having said that, there are some situations that we suggest people do or do not go on therapy even though they "fit" the guidelines.

You want to know the different types of medicines and what the different combinations are. You want to know what the side effects are and how they are taken. Your doctor will ask you lots of questions about your health and whether you have any symptoms. Your doctor will check to see what your white blood count is, whether you have any underlying kidney or liver disease. He/she will also check to see if you have been exposed to other types of infections. All these tests can help you and your doctor decide which medicines are best for you if you need them.

This is not a simple task for you or your doctor. It is very important that you make the right decision for you. Do you have a significant other in your life? If so, you should involve him/her early so he/she can help. Telling your loved ones and family can be very difficult but most find that family and friends are very supportive. Again, I would recommend you spend some time with someone who can help you learn about HIV, its treatment plus dealing with the many psychological and social issues associated with HIV. You should ask about seeing a case manager who can help you with any services you may need. You are not alone and we are here to help anyway we can.



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