Jul 20, 2002
I was recently infected on May 13-02 with hiv and had 1st labs drawn on June 20-02. My vl was 82793 and my cd4 was 450. My doctor was impressed with the numbers, expecially the vl being so soon after infection. He did advise that he was expecting a vl in the hundreds of thousands becuase my labs were drawn only five weeks after infection.
His intial response was to sit back and just monitor with followup visits and labs every 2-3 months. At first I agreed with him but then decided to go back and convinced him to start treatment. I'm seeing him agaim tomorrow for my prescription and instructions.
Just curious, does my vl and cd4 count mean anything considering it was taken 5 weeks after infection? Are my numbers good, bad, or is it too early to make a determination?
I'm thinking that by starting treatment now I can lower the numbers to a point that would allow me to take a structered drug holiday in the future in the hopes that my immune system will maanage on it's own.
Just curious to know what your thoughts are on my numbers and starting treatment now as opposed to later?
Response from Dr. Cohen
I am not aware of any info to suggest that we know how to interpret a week 5 viral load and its future prognosis in acute infection. While it may be lower than some others, it is possible you "peaked" at week 2 and are on the way down. This sadly doesn't tell us what to do, since as you point out, treatment now, regardless of viral load, may allow you to preserve a cell population that in the future could help control HIV replication in a way that appears to be lost if treatment is delayed. And since you get only one chance, I think treatment is a reasonable choice even if we lack proof.
Note that what to do and how to stop are also very undefined. As is the ultimate question of whether treatment early on is helpful. Fortunately the NIH in the US recently funded a network of sites, including one here in Boston, to address this issue. Those who are identified during acute infection, will be offered a chance to participate in a study from which we'll compare different approaches to treatment interruption and move this field forward a bit. It will require doing something that has been hard to do - which is to get people who are at risk, and who have symptoms, to seek care and testing for new HIV infection. But if these studies are successful, future answers can give you some guidance to your question. Until then, it sounds like you took a reasonble approach.
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