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High VL/High CD4: what to do?
#15243 - 01/30/01 04:50 AM
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Hi from Italy.
I'm HIV+ since Feb 00 and I discovered my status in June.
Since then I have regularly checked my situation having always high VL (from 60K to 240K) and high CD4 (from 750 to 1000).
My last analysis are VL: 200K and CD4: 907.
My doctor is now recommending me to start a treatment, but I ma very sceptical as I believe the longer I wait (staying in good health) the better it is (waiting for better medications).
I know that sooner or later I will have to start, but why now and not when my CD4 will drop to, let's say to 500.
What is your view about it?
Have you experienced something like that?
Thank you in advance for sharing with me your personal view.
Please, I do not want answers from denialists, thank you for refraining to answer.
Ciao.
Ale
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altazar
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Expert
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Reged: 11/14/00
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i would say the reason your id would want you tostart meds now is to get your v/l down because it is very high and cant be controlled with meds a lot quicker ,as for cd4 it is best to keep it high because once it drops ,getting it back to a normal level takes a very long time as opposed to getting the v/l to drop so i would suspect that that is his reasoning for wanting you to start meds now .
best of luck with what ever coose you make ,alt
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shadow1
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Reged: 12/06/00
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Hi Ale;
Im allso thinking on the same area as Altazar, if you start now you can get youre VL down, 200k is kinda high, but then I was there a couple of years ago, the only reasonmine came down is I am a cyclest, I ride over 200mi
a week, and the endorphins seem to have a great effect at bringing down the VL, but im not a Dr. and I dont know youre condition, or body type, etc. It worked for me, but it isn't right for everyone, i was diagnosed in 1989, and still havent taken any drugs for the HIV. I do have many friends that are doing wonderful, and have some that are on holidays, one has ben on a holiday for over a year and his VL hasent come back up yet. It's just food for thaught, not all of us have the same outlooks or body types, so it makes it hard to give advice on line. But thanks for posting.
The Gman
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maybe this article will help:
AIDS treatment guidelines revised for asymptomatic patients
Last Updated: 2001-02-01 17:00:46 EST (Reuters Health)
By Anthony J. Brown, MD
WESTPORT, CT (Reuters Health) - A revision of current AIDS treatment guidelines calls for delaying antiretroviral therapy
in asymptomatic patients until a more advanced disease stage is reached.
"The philosophy of the original guidelines was to hit hard and hit early," Dr Anthony Fauci, director of the National Institute
of Allergy and Infectious Diseases, told Reuters Health Thursday. "That philosophy was reasonable if you assumed that
antiretroviral therapy could eradicate the virus and ultimately get people off therapy."
However, Dr Fauci explained that since viral eradication is not currently possible, people will likely require therapy
indefinitely. "This shifts the risk-benefit ratio to looking at the long-term toxicities of treatment."
"If you look at people who have been treated for many years, there is an increasing incidence of toxicities ranging from
metabolic abnormalities, lipodystrophy, organ-specific toxicities, and emergence of resistant organisms," he stated.
Previously, antiretroviral therapy was recommended for asymptomatic patients with CD4+ cell counts of less than 500/µL,
viral load levels of at least 10 000 viral copies/mL of plasma on branched-DNA testing, or 20 000 viral copies based on
polymerase chain reaction (PCR) testing.
The current revision calls for delaying treatment until the CD4+ cell count is less than 350/µL or the viral load level is greater
than 30 000 viral copies by branched-DNA testing or 55 000 viral copies by PCR testing. In essence, "we are setting the
bar at a more advanced stage of disease," Dr Fauci noted.
From previous studies it does not appear that delaying treatment in this way will impact survival or time to development of an
AIDS-defining illness, Dr Fauci pointed out. However, this delay may help reduce the incidence of the toxic cumulative
adverse effects.
Dr Fauci emphasized that the treatment revisions were for asymptomatic patients only. "Guidelines for patients with
symptomatic disease, acute retroviral syndrome, or CD4+ cell counts less than 200/µL have not changed."
The revised guidelines, a joint effort of the Department of Health and Human Services and the Henry J. Kaiser Family
Foundation, will be released on February 5.
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Read this page:
http://www.jonkaiser.com/ch_2.htm
especially the parts that suggest viral load can be reduced without drugs, or with minimal drugs + complimentary therapies.
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princealbert
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Fanatic
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Reged: 05/21/00
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With a CD4 of 900, why would anyone want to start antiviral meds? Sure, the VL of 60K + sounds scary, but check out all other alternatives before you jump into the drug roller coaster. It will be there when and IF you really need it. I'd be thrilled to see CD4 that high, and check out every other approach to dealing with a high VL. Someone already gave Jon Kaiser's website. Also check out Project Inform and D.A.A.I. R.'s websites (both are accessible through thebody.com)
Above all, don't get stressed out, and let ANYONE talk you into an approach until you have the chance to think it through. Many of us have been living with this for a long, long time, and saw many years BEFORE any drugs existed. So theres no need to jump on that roller coaster if it;s not needed.
Also, take a look at Jon Kaiser's book "Healing AIDS" The title was a turnoff to me, but I really like his wholistic approach to dealing with HIV/AIDS
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> I'd be thrilled to see CD4 that high
Take low-dose IL-2. See http://www.kendallasmith.com/
The high dose stuff really fucks you up, but if you don't use too much it's not that bad.
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,My name is joe, I found out that I was positive in september of 1999. My viral load was 50,000,my cd-4 was 650. My doctor asked me about starting medication. So I did and since september of 1999 I have been undetectable. Also my cd-4 has come up, it is at 950. I feel very good, I live a normal life. I make sure I take my medicine on time,never missing a doze. I also never doe anything that would ever get me infected again. I first thought about killing my self , since then I have managed to deal with this real good. I really think that me starting my medicine early, and taking it on time ever day , never missing it has helped me so much.
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Unless the virus has changed, deterioration of inmune system seems to be IT, but you never know when is going to start. Before viral load test came out a few people mantained high cd4 for quite a number of years on single treatments (I wonder what their viral load was). With over 750 cd4 I would wait a little or think very well what to start with and why. Treatment strategies seem to be the key to good quality survival, the only thing is that no one has clear which strategies are those. Best of luck.
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