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viral rebounds after early treatment followed by STIS

Aug 15, 2004

Some recommend early treatment during the first few months after infection because it may be able to strengthen the body's own HIV specific defenses and then allow strategic treatment interruptions. People who have had such interruptions may do well for some months but seem to get viremia after awhile, so these studies have been seen as having mixed results. But is the viral load in such patients a year or so after treatment stops greater or lower on average than than the average VL in untreated patients at that period of time after infection?

Response from Dr. Pierone

This is the $50,000 question of primary HIV infection treatment. Are we just playing a shell game and after a fling with antiretroviral therapy and is it possible that essentially nothing has changed?

Studies have looked at similar groups of patients with newly diagnosed HIV infection, some treated, others not. It seems that those who did not receive antiretroviral therapy had lower viral loads after treatment was withdrawn. The treated patients also had lower levels of proviral HIV DNA which suggests that less seeding of reservoir sites occurred. But reports like this suggesting benefit from early HAART were not randomized and have enrolled relatively few patients, so we don't have definitive proof. The results are mixed, but suggest promptly treated patients may have better outcomes after treatment is withdrawn.

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