Question
Is starting treatment early better for me?
3 February 2012. Related: All topics, Side effects, Starting treatment.
Hello, and thank you for any advice. I was recently diagnosed with a CD4 of 444 and a VL of 10,100. My doctor said I may want to consider beginning Atripla. Though my numbers are not all too concerning at the moment, I wonder if starting treatment this early has a better result in keeping the virus in control. Thank you for your advice!
Answer
Before answering your question, it is important to understand that although you asked for advice, we are only an information service. The information is to help you come to your own decisions in discussion with your doctor. Although this distinction may seem small, it is important because we are not an advice service.
The decision when to start treatment is an important one. Current UK guidelines suggest starting when the CD4 count is 350. However, in some countries, including the US, guideline recommend starting earlier at a CD4 count of 500.
There are potential advantages and disadvantages of both recommendations. However there is not much data that suggests either one is better, at least in the short term.
By starting treatment earlier with a higher CD4 count, you will increase your CD4 count with treatment. This may have advantages in terms of your immune system. It also increases the chance of reaching and/or maintaining ‘normal’ CD4 levels. This is usually defined as being 500 or higher.
Also, for the time you are not on treatment your immune system is constantly active as it works to fight off the virus. So earlier treatment limits the time that HIV may be causing other damage.
These benefits of potential benefits have to be balanced against potential disadvantages. These include:
- side effects (though these are usually mild)
- changing your life to make sure you are adherent (taking your meds on time is essential)
- and a small risk of resistance if your treatment doesn’t work.
Currently there is a trial called START which is looking at whether it is better to start treatment at higher CD4 counts. This study will provide the best evidence for whether it is better to start at 350 or 500. Result should be available soon.
For more information on this please follow this link. Please note that this link gives more technical information about the trial.
Because your CD4 count is pretty good and your viral load is low, there is no urgency to making this decision. You have only just found out you are HIV positive and this is difficult.
So long as your CD4 count stays around this level, you can take your time and choose to decide when you are ready to start. It is also your choice as well to which drugs you choose to take. Even if you decide to start soon, a few months either way will not make much difference.
This link has more information about these choices. Information and knowledge will give you a better control over the type of treatment that is available. This will give you a better understanding of how HIV treatment works.
There are also a few facts that you need to know before starting your treatment. These links have more detailed information on starting treatment and potential side effects.
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