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Continue after Post Exposure Prophylaxis?
Mar 28, 2004

This February I had the misfortune of having sex and getting HIV. My sexual contact was on a Friday and by Wednesday I started having the "flu-like" reaction. My doc put me on PEP that day but unfortunately the window of opportunity passed and one week later I was HIV neg but with a 100,000 viral load. My CD4 count was 1150. My doc said the best case scenario now to be a non-progressor is to maintain the therapy (currently Viread, Epivir and Susteva) while another said I should stop and see what my set point will be. I am not having many side effects (just lightheaded with susteva) and my second labs were viral load of 1,000 and CD4 1100 still seronegative. I have read that treatment during acute phase is questionable(first six months), but how about continued treatment after PEP(2-4 days)? I am 29 and in good health. What is the best way that I can be 59 and in good health?

You and your colleagues are true HEROS fighting for all of us.

Thank You Dr. Young!

-OPTIMISTSTL

Response from Dr. Young

Thanks for your question, Optimiststl,

This is an area of considerable controversy, particularly since recent data from Dr. Bruce Walker's lab in Boston showed that there does not appear to be a significant change in viral load set point among persons who start therapy very early. This is a very different situation, than in post-exposure prophylaxis, where the person is probably not (yet) truly HIV infected.

Nevertheless, I'm waiting for additional data before drawing the very strong conclusion that treatment during acute seroconversion has no benefit. Until that time, for persons like you who are tolerating medications very well, one reasonable approach is to continue medications, with a close eye to upcoming research presentations. The worst that will happen is that you'll continue to preserve your immune function (excepting side effects or toxicity, of course).

It is my real hope that persons like you can live for decades-- careful monitoring of your health and medication side effects should permit this. Not a gimme, but a real chance for life with this chronic viral infection.

Thanks for reading and your kind words. BY



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