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1st Year Infection - Looking for Answers

Aug 21, 2003

Hello. I recently discovered this forum and am looking for help.

I was a victim of sexual assault in late December 2002.

I seroconverted in early January 2003, but didnt realize what it was at the time (high fever for several days, small red spots on upper body and face). Hospital blood test put my white cell count at 3.15, and they didn't do a viral load test or CD4 test, because they didn't suspect HIV. I tested negative for HIV.

In March 2003 my white cell count was 6.32. I got another HIV test and it confirmed what I suspected, that I was positive. Because of my knowledge of my own hiv testing and sexual history, it was easy to narrow down that the infection came from the assault.

I have begun treatment at my local hospital's hiv clinic, and twice this summer my cd4s were a little lower than 400, and viral load about 188,000. White cell count was 3.78, down from March's 6.32.

1. I was told that in many cases, this is typical for early infections, where the CD4 goes down then back up eventually, while the high viral load tapers down, and that both of these remain that way for any number of years.

My clinic suggested that I begin meds, but I want to do that only as a last resport or until I learn more about 1st year infections and typical occurances. I had a mild case of thrush which is under treatment now and almost gone. Other than that, I am very healthy, fit, strong, and all other values of my blood work are exceptional. I work out daily and have a good physique, eat very well and take a good regimen of vitamins and minerals.

Aside from wondering if its too soon to start meds, I am wondering if the SMART study has shown any indicators of people that are taken off meds by their care providers as a planned event.

Any assistance for a 1st year infection you can point me towards is great appreciated. Thank you very much in advance.

Response from Dr. Pierone

Should you start treatment now? Based on a CD4 count in the high 300 range with a viral load of 188,000 you can wait and get some more counts done over the coming months to determine the trajectory of CD4 and viral load levels. With a relatively high viral load you may need to on treatment sooner rather than later, but your are early in the course of infection and are certainly not in jeopardy.

I don't think there have been any formal reports yet from SMART regarding stopping medications, but we do have a sense of what to expect from other STI studies. Those with undetectable viral loads on therapy that stop treatment generally have a return of virus in blood from several days to several weeks after last dose of medication. There is often a fairly rapid drop in CD4 cells, sometimes rather dramatic in the first several months after stopping. The drop in CD4 cells then slows down to a gradual reduction similar to untreated infection. The magnitude of initial drop in CD4 cells is related to the lowest CD4 counts prior to starting therapy as well as the height of viral load prior to starting. (Those with low CD4 and high viral load before treatment lose CD4 cells faster and viral load tends to return to set point).

Getting back to your situation, you do have time to gather more information and see how things go. Good luck!

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