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Hit early and hit hard
May 28, 2005

Hi Doctor, A good friend of mine tested positive last April. Infection was most probably last January. His VL is 26200 and CD4 is 790. Doctor in Germany did not recommend treatment and proposed another test in three months. He asks about the hit early and hard strategy! what do you recommend?

Thanks

Response from Dr. Wohl

We don't do much hit hard/hit early anymore, although we are nudging back in that direction. There really is no good evidence that treating HIV at such a high CD4 cell count provides a benefit over delaying therapy until the CD4 count is lower (200-350). Balancing a desire to drive the virus down right away is the concern over the short and long term toxicities of the current batch of HIV therapies, the risk of resistance early in the course of infection if the medication is applied at high CD4 cell counts and the expense.

When we have therapies that can address these challenges we will see earlier use of HIV medications.

That said, during very early infection, so called acute HIV, before the HIV antibody tests become positive, treatment is commonly prescribed to preserve immune responses to HIV that can be benefical in the long run. But even in thses cases, therapy is often stopped after some period of time (months to years).

DW



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