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High viral load. Should I do something?
Jan 13, 2005

I was diagnosed two years ago and have always been between 100 and 200k viral load. I have not started treatment since my CD4 has always been above 600. I have had no symptoms or infections. My question is what damage is HIV doing to my immune system by just letting it go untreated like this? Especially, is my strain mutating eventhough no medication is being used? I am age 44. Thanks

Response from Dr. Pierone

Untreated HIV infection causes progressive damage to the immune system, but it typically takes many years for the effects to result in symptoms of immune breakdown. We don't like this "watchful waiting" approach and if the medications were safer we would be recommending earlier treatment. Actually, in the last several years the regimens have become much better and some prominent HIV experts are calling for revision of the guidelines to open the door for earlier treatment. The SMART study is comparing early treatment (no CD4 count or viral load limit) to delayed therapy, but results will not be available for quite some time.

The virus does undergo mutations, but in the absence of antiretroviral exposure it does not develop resistance to medications. One of the arguments against earlier treatment of HIV infection is that the virus can and will develop resistance to the medications if they are not taken properly. Hope this helps.

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