Question
Should I start treatment at CD4 320?
19 December 2009. Related: All topics, Starting treatment.
Hi
I was diagnosed with HIV 3 years ago. It hit me pretty hard and found it difficult to come to terms with. Over these three years my viral load has remained about 10,000 or so and my CD4 was 990 during seroconversion and gradually fell to 320 which is what I’m at now.
My HIV doctor suggested that I look at starting treatment but to wait until after Christmas. She suggested that I go on efavirenz and truvada. I have been reading up on these drugs and their side effects. I kind of feel like I’m losing the battle now but I don’t want to!
Does going on treatment mean I should be worried?
Basically what I want to know is how successful these drugs are as a combination, what are the side effects most commonly associated with them and should I worry about muscle wastage. I guess I’m also quite concerned about becoming sleep deficient.
I am 27, live in the UK, do not do drugs or smoke but occasionally I like a drink and my health is good other than my HIV.
Sorry it’s so long winded but I look forward to hearing from you.
Answer
Thanks for your question.
Nearly everyone’s CD4 count falls over the years and your own results are not unusual or anything to worry about. If anything, it seems like you are doing pretty well at controlling HIV as your viral load levels are still very low.
If your CD4 drop has been steady, and your CD4 percentage (CD4%) has also fallen, then it is probably a good time to start treatment. CD4 counts are still used as the best guide for deciding when to start, with most guidelines that recommend starting around 350 (compared to earlier guidelines a few years ago that set the guide at a CD4 count of around 200).
This move to earlier treatment is in part driven by having more effective treatments that have fewer side effects.
So please don’t feel you are losing any battle. It is just time to start using treatment, and the treatment will boost your immune system again and let you continue to lead a long and normal life. Treatment will reverse any decline, and your CD4 count will be back above 500 very quickly again.
Even at a count of 320, you can take time to look at the options and choices until you feel ready to start, and there is no problem with waiting until after Christmas.
The combination of efavirenz + Truvada is the first recommended treatment in the UK. It is very active against HIV and should reduce viral load to less than 50 copies/mL within the first month or two. Most side effects are more likely to be mild than serious, and if you have difficulties with one drug, then it is easy to switch to another.
None of these drugs are linked to muscle wasting. Although efavirenz can interfere with sleep patterns in some people, this can’t be predicted before you take it. Best advice is to start when you can take a few days off work – perhaps on a Friday evening – and then see whether this is going to affect you. Most people report that efavirenz-related side effects reduce over the first few weeks, and then become much milder. If they continue, or if they are very difficult, then switching to an alternative drug is easy.
Information about efavirenz side effects.
Information on starting treatment.
It must have been very difficult dealing with your diagnosis at 24 and it is good that you are now on top of things. Starting treatment will protect your long-term health, and is something you will also manage to make part of your normal everyday life.
If you have other questions, please let us call know, or call the i-Base phoneline after the new year.
Best wishes for a good Christmas and New Year
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