Good Morning Dr Mark,

First of all thank you all for the great support you provide us. I have been recently diagnosed (January 2009), after what had probably been a seroconversion in late December (high fever, night sweats for weeks, no cough, and 2 consecutive undetermined western blots in 1 month time). My first labs in mid February were CD4-599 and VL 145000, and my last labs in March showed CD4-520 and VL 270000. Even though I felt a bit tired in Jan-Feb, I am feeling pretty good now and asymptomatic. The first doctor I saw told me to start immediately with treatment using Reyataz+Norvir+Truvada, and told me that I might interrupt it after 3-6 months. I decided not to start treatment and because of my change in residence, my new doctor (at the Chelsea and Westminster hospital) told me that they recommend me to wait until Cd4 get lower.

Reading(and maybe over reading!) on the internet I see a lot of specialists that recommend to start treatment with a very high viral load in order to avoid destruction of healthy CD4 cells. Does it really make a big difference if you start at 500 or 350, and are there real advantages at starting treatment immediately after seroconversion if the viral load is very high? Thank you very much a best regards.

It probably does make some difference in the long run starting at higher CD4 counts. This is usually in people with longer chronic infection than you have, and is likely dependent on how high a stable viral load is. The data on starting HIV treatment during acute infection is mixed as to whether there are longer term benefits or not.