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recent sero conversion and when to begin treatment

May 29, 2005

I had a negative HIV test April 18th, followed by a positive test May 5th which was confirmed by Western Blot. I was very ill for 5 days when I had the first test with flu like symptoms, sore throat, and swollen glands but no fever. My doctor thinks I may have sero-converted between the two tests and that I was possibly only infected shortly before the negative April 18th test. I had the 2nd test because I had developed dry itchy skin with tiny red bumps the first week of April which first was thought to be folliculitis but did not respond to treatment. The only opportunities to contract HIV would have been March 31st or January 3rd, however, I was under the impression I had "safer sex" on March 31st, but not, unfortunately, on January 3rd. I began treatment on May 12th at the recommendation of my doctor with the belief I will be better off in the long term by starting meds soon after sero-conversion. I take Combivir twice a day and Sustiva once a day. My blood was drawn on May 12th, before I began treatment, and I received the results today, May 23rd. My initial CD4 count is 482 and my viral load is 107,000. Based on this informatin what is your opinion on whether I recently sero-converted? Do you think treatment was appropriate at this time before the lab results? (My doctor seemed suprised my viral load was not higher, and is seeking another opinion) If you think treatment is premature, is it inadvisable to stop now due to possible future drug resistance? My next blood draw to verify CD4 and VL is scheduled for June 13th.

Thank you

Response from Dr. Holodniy

Sounds like this was a recent seroconversion given the 2 test results. Early treatment has not conclusively been determined to affect long term outcome. It certainly will turn off viral replication and preserve immune function to a greater degree than waiting for some period of time (months to years). There are some down stream consequences (side effects) of long term treatment depending on what HIV drugs were started. If HIV treatment gets your viral load to undetectable levels, the likelihood of drug resistance with good adherence is remote.

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