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starting meds
Aug 11, 2003

I just recently had a very bad conversion illness, including cryptosprodiosis. My HIV antibody test was negative, but the doctors did a viral load test which came back positive. Before they even got the viral load test results back, they started me on Combivir and Sustiva, which I am currently on now. Is this wrong to have started me on meds so early? I keep reading all of these articles about NOT starting right away. And I have many friends who have never taken meds, and they are doing better than my friends on meds. Is it too late for me now to stop? Should I stop?? Should I seek another doctor? I am currently seeing an infectious disease specialist. Please help me. I am 20 years old, and want to live a long time. I appreciate your help. Thank you.

Response from Dr. Pierone

The decision to treat acute infection is difficult; we simply do not yet have proof that it is 100% correct. But, in my opinion, the preponderance of evidence suggests that early treatment is the right thing to do.

The rationale is that by treating early one can prevent widespread entrenchment of HIV in body reservoirs and favorably impact the long-term outcome. There may also be preservation or possibly enhancement of immune response to HIV with early treatment. The little data showing successful structured treatment interruptions has been in persons treated during very early infection. There may be a significant opportunity lost in not treating immediately for these reasons.

The counter argument is to wait and see, determine the virus "set point". The viral load comes down fairly quickly and CD4 cells will likely be above the traditional threshold for treatment of about 350 for years to come.

So if you do decide on treatment now, how long? Again, we just don't have hard answers. So we try to choose a prudent and cautious approach based on current understanding of the information available. What I recommend to my patients in your situation is to go on immediate treatment. Re-evaluate at 6-12 months and make a decision at that time about continuing treatment based on tolerability, adherence, and virologic and immunologic response.

The decision to change to another doctor depends on your rapport with your current one. The course chosen so far seems reasonable and don't worry, you will live a long time. Good luck!



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