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When should I start ARV therapy?

QUESTION:
There is a general acceptance that persons living with the HIV virus should be started on ARV therapy at a CD4 count of 350 (or is it 250?). I am not sure that this is safe since there are some infections that are always inactive in the body but activate in the absence of a strong immune system, like I have seen patients going blind all of a sudden. I have so much fear. Currently I am at CD4 count of 320 and I think the sooner I am started on ARV therapy the better for me. What is your take on this?

RESPONSE:
Many doctors advise their HIV-positive patients not to get on ART until their CD4 (or white blood cell) count has dropped below a certain threshold. This is because the body can contain the virus without medication for a long period of time, usually 8-10 years. During that period, the medication may help the body contain the virus, but it is thought to be unnecessary since the body is doing the job on its own.

Also, the medication, like many medications, is associated with toxicity and can eventually lead to drug resistance and the risk for this should be minimzed.

Bottom line: When to start ARVs should be discussed and agreed between you and a competent doctor who knows both about ARVs as well as you as an individual through appropriate monitoring of your overall health and CD4 count.

Finally, while your fears are certainly understandable, it may also be a good idea to seek out help to deal with these fears, whether through an individual counsellor who understands HIV and/or through a support network of people living with HIV. You can find some of the networks of people living with HIV in different parts of the world at:
http://www.uncares.org/UNAIDS2/living_positively/peopl e_living_with_hiv.shtml


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Date Created June 06, 2006
Author Admin
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