candida fungus, high viral load, start therapy

Question

Thanks for your time!

I was infected 1.5 years ago and had first test immediatly after with 430 CD4 and 449.000 VL. A year later I was 490 CD and 317000 VL. I have only had a new CD4 test today, but havent received results back

I have since 1 year a fungus in my mouth fungus candida, I think its called. I have taken mycostatin but it doesnt go away, but doesnt bother me.

I went today to a free health clinic for a CD4 test as private clinic VL and CD4 is too expensive. A nurse who took blood asked a bit of my history. I told her about fungus in my mouth. She said that with last CD4 of 490, high viral load and the fungus, it is a clear indication I should take medicine now.

My other doctor told me not to worry about high VL and fungus and only start thinking about medication when CD4 drops around 300.

What is your opinion? Should I start medication?

2nd question: I realized in the 3 blood tests I took since my infection 1.5 years ago, a falling platelete count from initially 150 to 102. I read that HIV also attacks platelets and one should start medication immediatly.

I don't feel like starting medication now and want to extend drug free time as long as possible.

What is your advise? Can I do this? Should I take medication now?

It is a bit of a problem for me as I am a foreigner living in Thailand with no health insurance in my home country and only local social security in Thailand. I am worried that I might not get good drugs for my body and have to take a lot of pills instead of one which I am confident I can manage.

Please advise me, I am really worried

thanks a.

Answer

The nurse is likely correct. Although your absolute CD4 count is relatively high, having the candida infection in your mouth and lowered platelet count; indicate the HIV infection is very active, and I would suspect your CD4% is much lower than the absolute CD4 count suggests. Because your viral load is quite high, I would recommend starting treatment. You will need to take at least 3 HIV drugs and Thailand has good HIV drugs that can be dispensed to you.