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New HIV Infection and Meds
Jul 4, 2003

I have been newly diagnosed with HIV. I am still under the 3 month mark (I was infected in May '03) They identified the virus with a PCR test - my VL is 35K and my t-cell is 954. My doctor is telling me that I am in a unique position to make a pre-emptive strike and not let the virus settle into my system. He is recommending that I go on meds right away - even though there is no research to support a "pre-emptive strike." He is prescribing sustiva and combavir - I am very confused as to whether I should start meds this early or wait - and the potential side effects and long term use of meds - need advice.

Response from Dr. Wohl

There are several theoretical benefits of HIV therapy initiation during primary (recent) HIV infection, however, there has been limited clinical data to support this strategy.

A great description of where we stand now regarding treatment during primary HIV infection can be found in the US Public Health Service Guidelines:

http://www.aidsinfo.nih.gov/guidelines/adult/AA_020402.html#H923C0F87E1E446B498051806557C2BF2

I have copied the relevant section below. My personal feeling is that such treatment may be beneficial and is worth pursuing in a motivated and knowledgeable patient. Talk it over further with your doctor. If you remain unconvinced, and fearful then you should not do it.

"Information regarding treatment of acute HIV infection from clinical trials is very limited. Preliminary data suggest that treatment of primary HIV infection with combination therapy has a beneficial effect on laboratory markers of disease progression. However, the potential disadvantages of initiating therapy include additional exposure to antiretroviral therapy without a known clinical benefit that may result in significant toxicities, development of antiretroviral drug resistance, and adverse effect on quality of life. Ongoing clinical trials are addressing the question of the long term clinical benefit of potent treatment regimens.

The theoretical rationale for early intervention is as follows:

to decrease the severity of acute disease; to potentially alter the initial viral "set point," which may ultimately affect the rate of disease progression; to possibly reduce the rate of viral mutation due to the suppression of viral replication; to preserve immune function; to possibly reduce the risk of viral transmission.

The potential risks of therapy for acute HIV infection include

adverse effects on quality of life resulting from drug toxicities and dosing constraints; the potential, if therapy fails to effectively suppress viral replication, for the development of drug resistance which may limit future treatment options; the potential need for continuing therapy indefinitely.

These considerations are similar to those for initiating therapy in the asymptomatic patient and were discussed in greater detail in the section "Considerations for Initiating Therapy in the Patient with Asymptomatic HIV-Infection".

The health care provider and the patient should be fully aware that therapy for primary HIV infection is based on theoretical considerations, and the potential benefits should be weighed against the potential risks. Many authorities endorse treatment of acute HIV infection based on the theoretical rationale and limited but supportive clinical trial data."



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