• 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.
