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Treatment during seroconversion
Sep 15, 2008

Hi

Is there any evidence that a short time early treatment during the seroconversion phase of hiv has an beneficial effect on the later disease development?

Thanks and best regards, Helmut

Response from Dr. Frascino

Hello Helmut,

The question of whether to recommend treatment during primary HIV infection remains a hotly debated topic. The clinical trail data that we have are limited and produced mixed results.

Some researchers have hypothesized that starting antiretroviral therapy around the time of initial infection may improve the immune system's ability to fight HIV, limiting the spread of the virus throughout the body and reducing the rate of disease progression. There have been conflicting reports as to whether this early treatment improves (lowers) HIV viral "set-point." Treatment during primary infection might also have a beneficial effect on long-term immune function, although here too the data are mixed. Researchers with the CASCADE study found that individuals who receive a three-month course of HAART during primary infection experience significantly slower CD4 cell decline during the three years following seroconversion. Other investigators, however, have shown this advantage does not appear to last long after treatment is discontinued. One final and more recent hypothesis arguing for early treatment concerns decreasing immune activation. As an immunologist, I would recommend offering HAART to all patients during primary infection, even though the risk-benefit tradeoff of very early treatment remains uncertain. The treatment pendulum is certainly swinging in the direction of earlier treatment. However, that must always be balanced by the risk of side effects and toxicities of taking antiretroviral drugs. I have no doubt that as HIV therapies improve, treatment will continue to be recommended earlier and earlier. Personally, if I had the option of being treated during primary HIV infection today, I would take it. But that is only my personal opinion as we don't yet have firm scientific data to completely support that position and make it a generalized recommendation or treatment guideline.

Dr. Bob


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