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treat early/wait
May 23, 2003

Dr., I can see the advantages of starting treatment in the acute stage in terms of salvaging a great portion of the immune system, but do you think this outweighs the likely risk of drug resistance down the road? Do you count on new drugs being approved when you issue meds to patients early in their illness? Thank you.

Response from Dr. Wohl

This is really a question that gets to the heart of our current debate regarding the timing of HIV therapy initiation - the trade off between the beneficial effects of viral suppression versus the cost of drug resistance and toxicity.

The calculus has led to an (temporary) answer that later is better in most cases. A major exception has been the application of treatment to those with acute HIV infection. In this case it is not just a matter of rebuilding the immune system but preserving it from the initial onslaught of HIV infection.

The long term benefits/risks of early treatment, its ideal duration, optimal regimen(s) and dosing all need to be worked out and are the focus of much research. The answers trickle out, however, due to the difficulty of identifying such acutely infected persons. Stay tuned. DW



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