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Demands HAART

Posted: May 11, 2007

QUESTION:

A 45 yrs old newly diagnosed Hiv female with CD4 796 cd4% 34.6 and VL3130 insists on starting HAART. Pt is otherwise well and rational. She is very aware of side effects and life long commitment to taken drug.Give her the prescription?


  

RESPONSE FROM:   

    It would be interesting to understand her rationale. If she is well informed and has appreciated that HIV therapies are now more potent and better tolerated, perhaps rendering the magical 350 CD4 threshold for treatment initiation obsolete and that unchecked HIV viremia has been associated with bad things like CVD - then this may be a reasonable and well reasoned request. Certainly, she would need to be aware that there are no data that clearly support the initiation of HIV therapy at such a high CD4 but such studies would be difficult to conduct.

    If, however, the patient harbors some false assumptions regarding HIV and HIV therapies that are motivating her aggressiveness - then some education is in order before a prescription should be written.

    DW




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