July #114 : Planning by Numbers

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Southern Discomfort

Hot Type!

The Rath of Con


On the March!


AIDS Walk of Life

OOPS, They Did It Again

Read It and Weep

Legal Eye

Everyone's a Critic

POZ Picks

Brad Pity

Aren't You Due for a Vacation?

Before Packing

Planning by Numbers

Cleared for Takeoff

Staying Healthy on Holiday


Welcome Home

The Scoop on Ice Cream

You Gotta Move It

Zip 'Em Up

2 Is The Loneliest Number

C Note

New Kaletra, Nice to Meet Ya

Zerit Dosing

Take it From the Experts

Forbidden Fruit

Altared State

Inside Job

Publisher's Letter

Most Popular Lessons

The HIV Life Cycle


Herpes Simplex Virus

Syphilis & Neurosyphilis

Treatments for Opportunistic Infections (OIs)

What is AIDS & HIV?

Hepatitis & HIV

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July 2005

Planning by Numbers

• CD4s above 350, premeds
HIV specialists mostly agree: STI success depends on your lowest-ever premeds CD4s—a.k.a your nadir—not your current labs. Boston HIV pro Paul Sax, MD, says: “Folks whose CD4s have never been below 350 can likely remain off therapy for months if not years.” Three studies conclude that even HIVers with nadirs of 200 can take breaks if carefully monitored. But some supercautious docs suggest CD4s above 500 (on meds) for a year pre-STI.

• CD4s below 350, premeds
Your STI prospects are iffier. Cal Cohen, MD, director of Boston’s Community Research Initiative of New England, which is conducting a multiyear STI study, says: “Some low-nadir people may have a rapid fall in CD4s. But about half will have at least six to eight months off before they need to restart.” Sax discourages those with nadirs below 350 from stopping therapy “unless there is bad med toxicity.” He says these folks “have the greatest risk of high viral-load rebounds and rapid CD4 drops when they stop.” But Cohen says, “On effective combos, you can regrow CD4s regardless of the starting CD4 level.”

• Travel Advisory: Treatment Failure
Three recent studies rule out STIs between ending a combo that has  bred mucho drug resistance and starting a new one. In this case, the STI may cause viral-load rebounds and big CD4 drops—and perhaps other health problems. One study found that HIVers who had tried several combos without reaching undetectable did poorly on STIs.

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