Med's For Primary Infection
Jun 19, 2004
You recently stated: "Based on the available evidence, I do think early treatment makes sense and recommend it for my patients, but with the caveat that it is unproven and the duration of treatment is not known." What available evidence are you referring to? Additionally, what is your recommendation for the duration of treatment? I have been on sustiva, videx ec, epivir since sero-conversion - and now have an undetectable viral load. CD4 is 812. I have been on treatment since August 2003 - undetectable since December 2003. Would you recommend the continuation of treatment indefinitely?
Response from Dr. Pierone
Hello and thanks for posting. In a nutshell, the available evidence consists of multiple small pilot studies or observational cohorts of patients treated with a potpourri of regimens of different duration. Some studies had structured treatment interruptions (STIs), others had experimental HIV vaccines; most were simply observations on what happens to series of patients in response to early treatment. Of course the results are mixed, but the sense that I get from reading these varied studies is that people treated very early seem to pretty well when they stop treatment. Pretty well, meaning that they do better than we would ordinarily expect. They have a tendency to have lower viral loads and signs of better and preserved immune responses to HIV.
How long to treat for primary HIV infection? Absent definitive guidance, I think 6 months is a reasonable time line. But the last patient I just treated for just 3 months (stopped after viral load became undetectable) because he had some challenges with medication access. 4 months after stopping his viral load is in the 1000 range and CD4 count 900. Admittedly, had he not been treated at all, it is quite possible that his viral load and CD4 count would be where they are now.
I would not recommend continuation of treatment indefinitely. However, if you have a personal bias towards staying on treatment and are having no side effects it is not unreasonable to continue. More data on treatment of acute HIV infection is being generated and you can stay on therapy and wait to see what the studies show. Good luck and keep us posted.
Here is a link to an STI overview that also discusses some of the original studies on treatment of acute infection.
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