Given the problems with long term toxicity, if the patient is willing to commit to treatment adherence, are you in favor of beginning treatment within the first six months of infection/seroconversion? Thanks for the great column.

Absolutely in favor of it - and also particularly in favor of research collaborations so that anyone who is started in that time point be offered the option of enrolling in a study that helps us learn about this very important issue.

What may be at stake in those who do start treatment soon after infection is the potential for establishing an immune system that is uniquely able to control HIV infection for prolonged periods of time, without help from the antivirals medications that most others require. While the data are still early and our knowledge still growing - there appears to be some consistency to the finding that those who do start treatment, and then undergo a process that expands the immune system's ability to control HIV - can potentially have periods of time off meds while maintaining low viral loads. Now, it may be that some will have a low viral load even with such early treatment, but it appears more likely with this intervention. And so, with treatment adherence in place - and multiple reasonably attractive regimens to consider - a period of treatment seems reasonable to pursue. Ultimately, if the concern with delaying meds is the story of cumulative toxicity - one way that might minimize this outcome is to bolster the immune system's ability to contribute to the fight. And starting early appears one such way.

Hope that helps. CC