When should I start treatment? CD4 count 674

[almar68]

Got tested poz on Jun 1st. Viral load was 84.5k - dropped to 47k on July 1st.
Drs say I should wait until it is under CD4 is under 500 or 350 to start meds.  Isnt it better to start meds immediately to get to undetactable viral load ASAP???!!!

[eric48]

to a similar question Dr B. Young provides here a well phrased response

http://tinyurl.com/HPC-YOUNG

Modified to add: Welcome here!

[tednlou2]

Welcome to the forums, although wish you didn't have to join.  Recommendations are now to start meds, regardless of CD4 count.  It sounds like you were recently infected?  Do you have previous neg results, which would give you some timeline? 

I think it really comes down to what you want.  Are you ready to start?  Are you the kind of person, who wants to treat now, instead of waiting around?  If you want to start, then you should.  The recommendations would back up that decision.  There is still debate on the benefits of starting above 500.  You can read that in this recent article.

All the best!

http://www.thebody.com/content/74697/starting-treatment-with-a-cd4-count-between-350-49.html?ic=wnhp

[stuka]

I was faced with a similar dilemma a couple of months ago. I know that there is no conclusive evidence that starting early (or as soon as possible) is always beneficial but most doctors seem to favor an early start if you can commit. Why give the virus a chance to set deep into your reservoirs and cause inflammation? Why make your immune system put up a fight and get depleted in the process when meds can provide a huge backup while your immune system is still healthy?

For me, when I tested my CD4 was 553 and VL was just below 10,000. I knew that I had time but I didn't think I had years, probably months or one year at best. Eventually you have to start, we all know that. What exactly can we hope for by delaying treatment.

[zach]

rhetorical question, what benefit could come from waiting? what would you wait for? until you get sick? this much is certain, you'll need meds sooner or later. do you want a weak immune system when you start or a strong one?

[almar68]

I dont know what is to be gained by waiting - maybe the idea that previously was there - the adverse effects of medications.

But, then, the question really becomes why dont doctors/bodies and government all out propose that treatment should immediately be started once diagnosed?...this is the part that confuses me...why is it not promoted as such??!!

[mecch]

One reason doctors don't recommend treatment at diagnosis is someone has to pay the cost. (I live in rich Switzerland and even here cost seems to be an issue.)

Rich countries with national health cares need to figure out a way to pay, if there was universal treatment, and at diagnosis... Rich countries do NOT get discounts on the drugs...   USA, with private/public insurance, and up to now so many many uninsured, also realise there is a governmental cost because that means govt sources of funding would be increased. And private insurers, they sure don't want to foot the bill.

Another reason is, if there is some leeway in the numbers, its a good idea to start HAART when the person is calm and collected, decided, and prepared. 

Finally, research in the mid to late 2000's suggested it wouldn't make much difference in the prognosis for the very long haul, years down the line.