Jun 30, 2005
you stated in another post: "hit early,hit hard" is balanced against... "...the risk of resistance early in the course of infection if the medication is applied at high CD4 cell counts" could you explain the reasoning behind this?
Woudn't haart, especially if it contained a CCR5 inhibitor or immunomodulator, prevent overall damage to the immune system and preserve CD4 diversity allowing for a better chance to proliferate an effective antibody to the virus.
Response from Dr. Wohl
Use of potent HIV therapy early in therapy can be justified by several arguments including the one you make. Specifically, that suppression of viral replication will limit damage caused by the virus to the immune system and allow for a more robust response to HIV and preserve defenses against opportunistic conditions.
However, a potential downside to early therapy is resistance. History demonstrates that most (not all) people on HIV therapies eventually experience viral rebound, typically with mutations. In fact, the proportion of people starting therapy who are undetectable a year later is generally no where near the 80% or so seen in clinical trials. If people develop resistance mutations at higher CD4 cell counts and cycle through successive regimens a possible result can be a genotype full of mutations at a high CD4 and fewer options when the counts start to dip into the red zone.
Now, this failure worry is based on historical data. Fact is, as you suggest, newer therapies that are even more potent are being developed. These may be harder to become resistant to and more forgiving of lapses in adherence. Such regimens, if they are free of long term side effects, could tip the balance way back to early therapy.
Get Email Notifications When This Forum Updates or Subscribe With RSS
- Can You Get Hep C From Kissing A Hep C Infected Person?
- How Long Do You Have To Wait Until You Can Get Tested For An Std?
- Pathophysiology Of Sexually Transmitted Diseases
- Short Term And Long Term Effects Of Genital Herpes
- What Does Hpv Cause?
- How Accurate Is The Orasure Advanced Rapid HIV Test?
This forum is designed for educational purposes only, and experts are not rendering medical, mental health, legal or other professional advice or services. If you have or suspect you may have a medical, mental health, legal or other problem that requires advice, consult your own caregiver, attorney or other qualified professional.
Experts appearing on this page are independent and are solely responsible for editing and fact-checking their material. Neither TheBody.com nor any advertiser is the publisher or speaker of posted visitors' questions or the experts' material.