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Seroconverting and Meds

Apr 23, 2006

I found out on Mar 6 I was positive. I became ill around Feb 10. The doctors think I became infected in Jan/Feb 06. Two sets of blood work have been completed. Mar 9 CD 4=960 VL=69,000 %=36 Ratio=1.24....Mar 30 CD4=1130 VL=37,000 %=34 Ratio=.84 Two of my three doctors are advising to start early treatment, the third is saying to wait. The two doctors want to save my immune system from further damage by starting early treatment. I've heard that there has been a study completed that may suggest a benefit of early treatment with a possibility of stopping treatment at around 18 months. My doctors are leaving the choice up to me and I have been receiving conflicting information on starting meds early versus waiting. Can you comment?

Response from Dr. Holodniy

You will not get a consensus among experts as to how to proceed. The ultimate question is does very early treatment affect clinical outcome, and that question will take years to answer. The devil is in the details as to what the "benefit" is/was in the studies that have addressed this question. Did the study just look at CD4 count or viral load thresholds after treatment? Did they look at more sophisticated immune function tests to see whether indeed immune responses were preserved or improved? Did treatment start immediately after infection (within days to a few weeks) or later (after 2-3 months or longer). Small studies looking at all these angles have been done and have yielded conflicting results as to benefit. Finally one has to balance the potential for long term toxicity of HIV meds if you start too early. In my opinion, you are already in the early chronic phase of infection and I am not sure what is to be gained by starting now and would not recommend starting treatment. But that is one guy's opinion. So unfortunately you now have an even split.

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