Question:

Dear Doctor:
I am a 54 yr. old white male who has known of his HIV status since 1986. I have been on HAART (Crixivan, 3TC, Videx EC) since the beginning of HAART; my viral load remains undectable and all other monitored blood parameters have remained in acceptable ranges.

I have been feeling somewhat guilty as to the amount of money spent on me to keep me healthy, as I am on Medicaid.

My question is this: in order to economize on expenses, how often should I have blood work performed and just what parameters should be monitored when blood is drawn?

Thank you for your assistance.

Answer provided by:

Mark H. Katz, M.D.
Regional HIV/AIDS Physician Coordinator
Kaiser Permanente of Southern California

Hello!
That you feel this way shows you to have a fine sense of compassion: If we think of all the persons in the world with HIV who do not have ready access to care and treatment (more than 90% of the world's 40 million plus who are infected), it is overwhelming, and perhaps all of us--whether living with HIV or not, doing well or not, would have some of these same feelings which you do.

That said, it is good that you have maintained the same regimen for all of these years. Monitoring the viral load and T-cell count quarterly--perhaps this could be spread out to every 4 (6 if you really wanted to and your provider agreed)--is the usual standard. Many times other lab tests come into play as well: For example, you generally need a CBC to do a T-cell panel, plus many persons living with HIV have lipid levels checked, and men who have sex with men have screening for STDs such as syphilis.

Some would suggest that you consider going off your treatment to see what happens to your viral load and T-cells. I am not suggesting this based on what you wrote--the decision to do this depends on a multiciplicity of factors and should be discussed with your provider.

Lastly, given that you have done so well for so long, and you seem to be a person with a sense of social responsbility and empathy--may I be so bold to suggest that you channel some of this energy into helping others less fortunate? For example, for my birthday each of the last several years I ask my friends not for a gift but to donate something to an AIDS service group.

In any case, good luck and keep up the good work you are doing!

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