Question
Should I start treatment with a high CD4?
8 October 2012. Related: All topics, CD4 and viral load, Starting treatment.
I was diagnosed in May of this year and so far my counts have been:
May – VL – 365946, CD4 – 862
Jun – VL – 16505, CD4 – 1011
Sep – VL – 46958, CD4 – 1001
Right from the onset, I asked about starting meds as I would like to be a bit proactive with my HIV and get it to an undetectable level.
Although my CD4 counts are really good, there are still figures for viral load.
However, during the course of the last few months, I’ve been speaking to a few people and some have said that it is better to postpone starting meds if you can and others have told me that it is better to start meds because then your viral load will come down, etc.
What I did stand by, right from the start, however, that I wasn’t prepared to wait until my CD4 went to 350 before starting meds; I made my own personal cut off point at about 500/600.
I was at my appointment today (to get my September blood results) and had a long consultation with the doctor. He has taken another resistance test and also has to speak to a Neurologist (I am gene positive for Huntington’s disease) to ensure there is no contra-indication if I become symptomatic for that.
My head is a wee bit all over the place – on one hand, I would like to start meds and get my viral load down to undetectable level but, on the other hand, I don’t want to go onto meds and go through all the side effects at the moment if its not necessary.
Sorry guys if I have rambled on a bit. I really have got my head round my diagnosis from May but I am a wee bit worried and a bit lost about the starting meds situation; I hear horror stories about side effects, etc and just need a bit of guidance.
Answer
Thank-you for getting in touch. I’m sorry to hear that you are feeling worried about starting treatment.
Your CD4 count is very high, and your viral load is OK. According to the UK treatment guidelines you wouldn’t normally start treatment until your CD4 count was around 350- or your viral load is above 100,000.
Do you know if you were diagnosed soon after infection? Your high viral load in May, and the increase in your CD4 since then, suggests you may have been in a period of primary infection in May.
I can’t give you advice about whether to start treatment or to wait, as this is a decision you need to make together with your doctor. Unfortunately there hasn’t been a study to determine when the best time is to start treatment. Although there is a study called ‘START’ going on this is looking at the difference between starting when your CD4 is over 500, and waiting until it is 350. Your CD4 count is so high above this point that it is very difficult to say what clinical benefit there would be to starting treatment now.
In this previous question I explain why different countries have different guidelines for starting treatment.
If you would like to talk through your concerns please give us a call on the phone line (0808 800 6013). Or if you send an email with your personal email address I can discuss your situation in more detail.
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