Question

What is the recommended HIV therapy for people with viral load of 100,000 but with a CD4+ of nomal range 600-1,300)?

Answer

Trick question!

Many docs, maybe this one, would not treat someone with a really high CD4 - even if the viral load is 100K. The idea is that with close monitoring, therapy can be started when there is an evident decline in CD4 cell numbers or when they hit a certain level (i.e. 350 or 400 or 500).

For those inclined to be a tad more aggressive, well, there are plenty of choices. Traditionalists can look up the Department of Health and Human Services (DHHS) guidelines and check out the list of preferred regimens for first-line therapy. These are either Kaletra-based or Sustiva-based. Those willing to deviate from party line can choose other anchors such as ritonavir boosted Reyataz (or even unboosted Reyataz if Norvir would be a problem) or boosted Lexiva, for example. Viramune would not be attractive as it is contraindicated in those with high CD4 cell counts.

What to accessorize the protease inhibitor or Sustiva with can be found in the guidelines, too. Each has their ups and downs that you and your doc can discuss at length.

DW