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Ask the Experts about Understanding Your Labs
Time to start for someone on borderline of recommendation starting conditions
Jul 27, 2008
I have been HIV+ for around 5 years.
For the last 4 years, my stats have been stable:
A viral load of <5000
A CD4 of 340 +/- 20
A percentage of 27%
I travel internationally for my work, to many countries in the South. I mainly visit capital cities.
I am healthy and only had two days off work for illness in 4 years. This was just a common cold.
I live in a monogamous relationship and lead a "plain", "ordinary", low risk life (e.g. early to bed, no drug use etc).
I am trying to balance:
i) The current recommendation being to start on CD4 350 or below
ii) The growing evidence that starting early is better than starting late
iii) The inconvenience of taking meds
iv) The risk of longer term side effects.
For someone on the border-line of the current recommendation, is there any better way of deciding whether to start medication other than going with my heart (or flipping a coin)?
Response from Dr. Holodniy
You have distilled nicely all that goes into making decisions to start HIV treatment. Given your 4 year history of stable CD4 counts, healthy CD4%, and low viral load; I would recommend not starting treatment at this time. This obviously can be revisited if your numbers change significantly, or new knowledge becomes available that emphatically concludes that treatment is required for all people regardless of where they are on the HIV spectrum.
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