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starting treatment early fears. when does set point come
Jul 1, 2004

Infected just under two months ago. Seroconverted with illness after six weeks.

CD4s just over 800 (45%), CD8s just under 500 (28%). Absolute lymphocytes 1780 21.9%.

How long after seroconversion is VL set point likely to arrive?

I am afraid to start treatment now because I would like to have a few "well" years first.

I am concerned that early treatment will lead to viral failure or resistance and remove later options. On the other hand, studies seem to show that people treated this early can then interrupt for a few years. However, won't they then have to start treatment again at the time when they otherwise would have started treatment for the first time? So mightn't they save themselves a few years of treatment by just starting later? Or is there evidence that starting earlier and then stopping can delay the need for treatment later on?

Also in a patient without existing problems in specific organ systems, is there any evidence about which therapy combinations have least likelihood of causing fatal side effects or severe psychological problems?

Response from Dr. Pierone

Your comments and questions highlight the uncertainty that exists regarding early treatment.

We have limited evidence that suggests early treatment may make a difference in the long-term outcome of HIV infection, perhaps by changing the set point. How would early therapy change the set point? If it does, (and this is by no means proven), it may do so by preventing widespread dissemination of virus to reservoirs and facilitating a more effective immune response. Newer treatments are less toxic and easier to take than older regimens, so initiation of medication for primary HIV infection is a reasonable approach.

But as you indicate, maybe early treatment is just a shell game and simply shifts treatment to a point sooner rather than later. And your rightly point out that there is a risk of medication-related toxicity and early development of resistance. Fatalities are extremely rare, but have been associated with Viramune (liver), Zerit (lactic acidosis), Videx (pancreatitits), and Ziagen (hypersensitivity).

The timing of set point is probably in the 6 -12 month time horizon. It sounds like you are not ready for early treatment and there is nothing wrong with waiting (since we have no proof of its effectiveness). Best of luck to you!



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