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Am I a candidate for treatment?
Mar 16, 2002

I seroconverted exactly four months ago today, and had an "undetermined" test result one month ago. I followed this with a viral load test and learned that my viral load is 4,070 and my T cell count is at around 500. I've been to two doctors for opinions, and one said the current thinking is to wait for meds until I need them down the line. The other doctor believes I am a candidate for structured interruption treatment since I am newly seroconverted. He suggested a daily regime that includes Ziagen, viread and epivar. I am a pro-active person, and frankly, the idea of sitting around and waiting for a few years makes me a little uncomfortable. On the other hand, I want to make an informed decision before committing to a serious drug regimine. I should add that I think both doctors are excellent. I have done much research, but find so much conflicting information. Can you offer any insights to someone in my position? Thank you for your consideration.

Response from Dr. Young

There is conflicting information and opinion about just when to start medications. I certainly won't be the first or last person to chime in on opinion.

The first issue relates to possible benefits to initiation of therapy during acute infection; it is not clear at this point (4 months) if you really are still in the acute phase or starting into established, chronic infection. There are potential benefits for early initiation during acute infection-- these include improved viral response and preservation of certain types of HIV-specific immune responses. The best way to find out if you are in this acute phase would be to check in with your local research center-- using special tests (like the detuned antibody test) it would be possible to figure out which boat you're in.

Aside from acute infection, most (but not all) opinion leaders would likely suggest deferred intitiation of therapy, particularly with a viral load of only 5000-- you could expect that your CD4 cell decline to be very slow.

As to what exactly to start on, there has been a lot of excitment about simple and potent twice- or once-daily treatments-- like the one that you've listed (abacavir/3TC/tenofovir). Understand, though that this particular regimen has not yet been studied prospectively; there is little data to understand long-term durability (though it should be great), or resistance at time of treatment failure (this impacts strongly future treatment options). We do have substantial, evidenced-based approaches that have been proven to work (take for example, Combivir with either Kaletra or efavirenz; these are not the only approaches, just some with recent long-term results)-- I tend to stay with proven approaches with prospective and comparative clinical trials data. We have embarked on an era where we should expect to have long-term success of therapy; I'd hate to gamble with an untried or unproven approach, unless under the auspice of a clinical trial.

Hope this is helpful, BY


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