I am an experienced HIV treater,but with minimal new seroconverter or teen ager experience. Is it still felt that 'preservation of the immune repetoire of CD4 and other lymphocytes' is a very desireable prompting very early HAART use for an asymptomatic 18 male MSM whose HIV test converted within the last year.. Should treatment strictly be based on the CD4 being at 350 cells or less plus VL > 50-100,000 copies before starting HAART...or is there still a concensus in any guidelines to innitiate RX earlier for recent seroconverters to preserve immune system. How do I advise this young man?

Currently, it is still important to differentiate between acute infection (prior to full seroconversion from HIV antibody negative to positive) and recent HIV infection (serconversion recently transpired). For the former, there is interest in using HIV therapy to preserve immune responses directed against HIV. While many clinicians do treat during acute infection, it is not exactly standard of care yet. For recent HIV infection there is much less enthusiasm for treatment and not much data to support therapy. The thought here is that by this time there is less opportunity for early treatment to have an impact on immune responses to the virus.

There are studies now underway to explore this further. Meanwhile, in a patient with recent HIV infection who has fully seroconverted, I would treat only within the context of a clinical trial or if and when there are indications for treatment based on the current guidelines (low CD4, high viral load, symptoms of HIV disease).

DW