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Am I doing ok?

Apr 30, 2006

Hi, I was diagnosed HIV positive almost 2 months ago. With Acute infection I understand that the viral load goes as high as a million copies. A few weeks ago with the last test results we found out it to be 50000 copies per ml blood. I hear this will continue to go down drastically until it reaches the set-point. My t-cell count is 550. And I am participating in this study in which Cyclosporin is used in addition to Trizivir and Kaletra, to put the healthy t-cells in sleep so they don't get infected. I don't drink, I work out a lot and further everything else about my test results were perfectly normal. I am 29 years old.

I hear mixed messages about whether it is a good idea to start early with medications or not. Some say yes and some say no. What is your opinion about my condition and early treatment (it is a one-year trial) choice?

Further: The only side effects I show so far is nausea and gas. I hear especially the protease inhibitors may result in changes in physical appearenace (wasting or fat gaining). What is your opinion on this?

Response from Dr. Holodniy

Your viral load after acute infection, in the absence of HIV treatment, usually stabilizes after 6 months. You may stabilize at 50,000 and so it is hard to predict where you will land. Treatment during acute infection is still controversial and thus, should be done in clinical trials where things are controlled and people are followed regularly and objectively. You will hear experts supporting both sides. The devil is in the details as to when acute infection really is. Since infection is already established, you are not preventing infection. Then it becomes an argument about preserving the immune system, which has to be balanced with the potential for long term toxicity of HIV treatment. I am inclined not to treat during acute infection unless I see very rapid progression, which occurs very rarely.



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