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Stopped treatment after 4 days during acute infection
May 24, 2004

Thank you for all the information available on this site. I know the question of whether or not to start treatment during acute infection is a popular one, but I have a slight variation.

I was diagnosed with HIV a few weeks ago via viral load testing. My HIV tests are still showing negative indicating recent infection. As of a couple of weeks ago my CD4 was 580 and viral load was over 175,000. My Dr. put me on meds with the intention of leaving me on them for 6 months. The problem was after 5 days on them I could not take the side effects. He offered to switch my treatment but instead I decided to stop treatment.

Do you think stopping treatment after such a short time will cause me problems down the road with drug resistance?

Overall, I just couldn't handle the side effects of the drugs and worry about being on them forever if I start this early. I have yet to meet someone who went on meds during acute infection who was able to go off of them for longer than 6 months.

Thank You

Response from Dr. Pierone

Hello and thanks for posting. A five day treatment course for acute HIV infection will be very unlikely to result in development of viral resistance. One point that is not always stated in the discussion of management of primary HIV infection is that resistance testing should be done routinely to make sure that transmitted virus is not already resistant to some of the medications.

You did not mention the regimen that made you sick, but there are wide arrays of cocktails available and they vary considerably in their rate of side effects. The inability to tolerate your initial one does not mean that that much when it comes to future choices (just don't take what you took this time). That said, your decision to forego treatment was not unreasonable, we don't have any proof that treatment of primary HIV leads to long-term benefit. There are reasons to think it might, but the original very high hopes (Berlin patient, Mass General cohort, etc) have been dashed, and current studies will test the hypothesis that there may be a more modest benefit conferred by early treatment.

There are lots of people that went on treatment during acute infection and have stayed off them for more than 6 months and the same is true for people not treated during primary infection. There is no evidence that going on treatment early makes someone dependant on HIV medications. There are numerous unanswered questions about treatment of primary HIV infection and studies currently underway should help guide us in the future.

Based on your negative experience with medications it sounds like you made a sound decision to stop. You should be able to tolerate future therapy (which may be many years into future) with a different regimen. Best of luck!

Four years since infection: time to start treatment?
High Viral Load

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