HIV Digest	HIV Digest Archive

Question for TheBody.com's "Ask the Experts":

I have had HIV, as far as I know, since 1991. I discovered that when I was rushed to the hospital for developing diabetes. I have been healthy and usually do not even have colds or flu. My latest CD4 count is 660 and viral load is 50,000; five years ago it was at 1,100.

My doctor wants to start me on Truvada, Reyataz, and Norvir. He tells me it is a good time to start because this will drop my viral load to undetectable. When is a good time to start and is this a good combo? By the way, I also take blood pressure and cholesterol medication as well as the insulin; my liver and kidneys are in great shape. I weigh about 200, am 5'8", and 47 years of age.

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Response from Dr. Sherer: The new Department of Health and Human Services (HHS) guidelines advise that all patients with CD4 counts below 350 be treated with anti-retroviral drugs. They also state that treatment may be warranted in some patients with CD4 cells above 350; for example, a baseline viral load above 100,000 is associated with a higher risk of HIV disease progression, and is an additional consideration.

In your case, your doctor may be concerned that the viral load is increasing, even if it is not above 100,000, and that your CD4 cells may decline more rapidly now than in the past. Together you can review the past trends in your CD4 cell count and viral load, as well as your resistance test results, to make the determination if treatment is warranted, and to choose the optimal regimen for you.

Your doc's recommended choice of ART is among the "preferred" regimens in the HHS guidelines for initial therapy -- it's a good choice, and there may be several good alternatives, depending on your resistance test outcome and the side effects that you might anticipate with the various options.

from TheBody.com