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Low Viral Load, but early Infection
Jun 1, 2003

I am 35 and I have a viral load of between 8,000 and 16,000. My CD4 is 1000. I was infected about three months ago. I've heard that there is a theoretical benefit of starting treatment during early infection. Have I missed that window of opportunity? Given my numbers, would you recommend starting or delaying treatment? I have no adherence or financial issues regarding drug therapy. Thank you.

Response from Dr. Young

Yours is an interesting situation-- I'd normally expect that someone with acute or recent HIV infection to have avery high viral load.

Indeed, one of the goals of early treatment is to cause the viral setpoint (the viral load during chronic infection) to be lower than average. A lower viral load setpoint correlates with a high liklihood of having very low rates of CD4 cell decline and therefore a longer time before AIDS.

You have not formally reached the end of the window of opportunity, but I'd want to know more about whether your HIV antibody test is fully positive yet (since this correlates with the end of the acute infection stage).

Starting treatment for you probably comes down to a number of individualized issues- there might be some immune benefits to being on therapy, though your viral load right now is very, very low-- so low that you might already have a reasonably high liklihood of having very slow disease progression.

I'd probably use the antibody test to break the tie-- if the test still is negative or indeterminate (and your viral load tests are positive), then I'd consider starting (since the liklihood of having benefit is greatest at this stage). By constrast, if your antibody test is already fully positive, then the potential benefit of early therapy is less, and I'd probably defer on starting.

I hope this helps with your thinking. BY



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