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Early Diagnosis and Treatment
Jun 21, 2005

I was diagnosed as positive one year ago. Had regular blood work so from the time I was infected to the time that I was diagnosed was approximately 3 to 4 months. At the time of the initial diagnosis, CD4 was at 531 and viral load was at 18,000. I was treated with Trivizir and after a year my CD4 is 914 with an undetectable viral load. My meds were recently changed to Zerit and Reyataz. I am pleased with the reults so far but at the expense of my energy level, I am extremely fatigued. What are your feelings on beginning a regimen of drugs as soon as being diagnosed? Is there a downside to this? Thank you.

Response from Dr. Pierone

Hi and thanks for posting.

One downside to being on HIV medications very early on is the risk of medication-related side effects (like fatigue, for example). Another potential downside is the possibility of developing drug resistant virus which might compromise future treatment options. I mention resistance because dual therapy like Reyataz and Zerit is a bit risky. If you said the Reyataz was being boosted with Norvir, it would still be considered dual therapy, but would be much less risky.

The upside to early therapy is having an undetectable viral load and CD4 count in the normal range. Also, you mentioned that you started therapy within 4 months of infection. Some would consider this initiation of therapy during primary HIV infection and might be a good thing. However, the jury is still out as to whether HAART for primary HIV results in positive long-term outcomes.

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