Treatment of Acute Infection?
Mar 6, 2004
Thanks for all your great work!
Just wondering about something. I started treatment for acute infection (vl>700,000, CD4 200, antibody neg) about 6 months ago. I was very sick at the time and got cryptosporidiosis. Now I feel pretty much fine. Take a once a day regimen (TNF, 3tc, ATZ/RTV). No complications though lipids are slightly up (cholest - 202, HDL - 41, LDL - 146, tri - 71). Probably from all that creme bulee'.
My question is that with some of the new data at the retrovirus meeting saying that treating acute infection doesn't seem to be that helpful, is it worth it to be on treatment? I don't want to get sick again, and I don't seem to have many complications from treatment so...?
Thanks so much!
Response from Dr. Pierone
The data from Retrovirus was discouraging with regard to longer term outcomes in patients that received treatment during primary HIV infection (PHI). The hope was that early treatment might allow people to stop treatment and enjoy a prolonged time with virologic control. This appears to be the case early on, but as time goes progressive viral mutations allow immunologic escape and viral load increases. See this link or coverage from the meeting.
Even though prompt treatment of PHI is not by itself sufficient for long-term control, this does not mean that there is no benefit from this strategy. The only way to tell for sure is to a randomized trial of treatment versus observation.
It sounds like you are tolerating therapy well and I assume that the viral load is undetectable. The decision to stop or continue must be individualized, but my general approach would be to stop treatment at some point within the next 6 months and see what happens to the viral load and CD4 count. Having said that, many people in your situation would prefer to stay on treatment for a longer period of time and wait for more information to come out on treatment of PHI. I would have no argument with this approach, since the duration of initial treatment might be an important variable in determining eventual outcome. There are anecdotal reports of people started on HAART during PHI, treated for several years, then maintaining prolonged virologic control after stopping. Were these people destined to have virologic control anyway with a low set-point absent treatment? We simply don't know. I hope you were not looking for a simple yes or no answer instead of a 'maybe'. In any case, best of luck to you and let us know how things go in the future.
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