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Starting HIV Meds Early
Jul 15, 2007

I was infected with HIV in September of 2006. My first labs were done in April. My VL was 74,000 and my CD4s were 864. My resistance test came back as no resistance to anything.

I hate the idea of waiting for my CD4s to drop before starting treatment. I'm also in a serdodiscordant relationship and I want to minimize any possible risk of transmission (we practice safe sex, but I still get freaked out about infecting him).

What are the pros and cons of starting treatment now? What combo would you recommend? I'm in my early 30's and in excellent health.

Thanks!

Response from Dr. Pierone

There are several positive features associated with early treatment of HIV-infected. One that you have alluded to is that there would be a much lower risk of HIV transmission in the case of condom breakage. Another is that early treatment of HIV infection prevents damage to the immune system, and although later treatment produces immune reconstitution, there may not be complete recovery. Other studies have suggested that untreated HIV infection is associated with subtle neurocognitive deficits, and if this is true, then early treatment might prevent this problem from developing.

Of course there are risks associated with early treatment. These include drug-related toxicity, both short-term and long-term. There is also the risk of developing drug-resistant virus which could lead to limited future treatment options. There is also the financial cost of medications, which is considerable. There may additional costs associated with other medications to treat potential side effects. For example, there might be a need for lipid lowering therapy if the HIV medications significantly increased the cholesterol level.

Atripla is a combination of Viread, Emtriva, and Sustiva and although it is not right for everyone, it appears to be the best current regimen based on its simplicity and effectiveness.

Best of luck to you!



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