recent sero conversion and when to begin treatment
May 31, 2005
I had a negative HIV test April 18th, followed by a positive test May 5th which was confirmed by Western Blot. I was very ill for 5 days when I had the first test with flu like symptoms, sore throat, and swollen glands but no fever. My doctor thinks I may have sero-converted between the two tests and that I was possibly only infected shortly before the negative April 18th test. I had the 2nd test because I had developed dry itchy skin with tiny red bumps the first week of April which first was thought to be folliculitis but did not respond to treatment. The only opportunities to contract HIV would have been March 31st or January 3rd, however, I was under the impression I had "safer sex" on March 31st, but not, unfortunately, on January 3rd. I began treatment on May 12th at the recommendation of my doctor with the belief I will be better off in the long term by starting meds soon after sero-conversion. I take Combivir twice a day and Sustiva once a day. My blood was drawn on May 12th, before I began treatment, and I received the results today, May 23rd. My initial CD4 count is 482 and my viral load is 107,000. Based on this informatin what is your opinion on whether I recently sero-converted? Do you think treatment was appropriate at this time before the lab results? (My doctor seemed suprised my viral load was not higher, and is seeking another opinion) If you think treatment is premature, is it inadvisable to stop now due to possible future drug resistance? My next blood draw to verify CD4 and VL is scheduled for June 13th.
Response from Dr. Pierone
Based on what you have outlined it sounds like you had seroconverted by May 5th and the symptoms of primary HIV infection occurred about 3 weeks before that. A viral load of 107,000 is not out of range for this May 5th time point. Very high viral load readings are more likely when someone is tested before the immune response to the virus and antibody production begins. In your situation, had a viral load been done at the time of the negative April 18th antibody test, it is likely that a significantly higher viral load would have been measured.
Now that you are on therapy it seems reasonable to continue. We don't have proof that early therapy improves long-term outcomes, but there are intriguing data that suggest benefit. Development of resistance depends on the degree of adherence to this regimen. If you do not miss doses you should not get resistant virus. How long to continue medications now that you are on? Because we don't know, it is not unusual to choose some arbitrary time point like 6 months or 1 year and then stop. This decision can and should be individualized if someone is struggling with adherence and side effects then stop sooner. Others that are tolerating the cocktail well have chosen to continue medications until ongoing studies hopefully clarify the situation.
Hope that this helps and let us know how things go.
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