Question

Should I start treatment if my CD4 count just dropped to 276?

23 July 2011. Related: All topics, CD4 and viral load, Starting treatment.

I was diagnosed Oct 2010. My cd4 count over the past 9 months or so has ranged from 458 (highest) to 276 (lowest). I’m currently at 285 with VL around 20k.

My doctor has said I should start treatment in the next month or so which I was happy to do. However since thinking about it and researching side effects etc I’m beginning to think otherwise and considering alternative therapy.

I’m 35. I eat right, exercise regulary (run 15-20 miles a week no problem) and I look after myself and am never ill. I’ve not had any weight loss. I’ve not even caught so much as a cold for as long as I can remember. I don;t even get hangovers when I’ve had one to many! Considering my cd4 count dropped considerably (190) over the course of  a couple of months I showed no signs whatsoever of illness etc

I don’t really want to start treatment until absolutely neccessary.

Any thoughts greatly appreciated

Answer

Answer: Simon Collins

Hi

You have time to decide what you want to do. You could see whether your CD4 percentage (CD4%) has also changed. If this has been stable over these absolute CD4 test results, then your next CD4 count might easily be a bit higher next time.

However healthy your lifestyle, which is a great thing, there are no alternative therapies that are active against HIV other than combination therapy with HIV meds. HIV drugs are generally very safe and effective and will keep you alive and health for many years when you come to use the.

The greatest shift in prescribing HIV treatment has been to move away from waiting until ‘absolutely necessary’. This is because although you feel and look healthy, the time you are not on treatment may be affecting your long term health. This doesn’t mean everyone needs to urgently start treatment. The evidence is not there for people with higher CD4 counts. Just that having detectable viral load for many years, even at relatively low levels, might be contributing to long term problems.

See the Introduction to Combination Therapy guide for more detailed information all these questions.