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Acute Seroconversion
Jun 25, 2008

Is there any corelation between the clinical course of HIV and the intensity of the acute illness experienced during initial sero-conversion? I was hit like with a ton of bricks right off the bat within weeks of contracting HIV. I had a constant fever, developed colitis and other stomach disorders wasting away quickly. I started meds right away (Sustiva and Truvada) with my initial viral load of at least 100,000 and my CD4 at 938 (20%). After 12 weeks my VL is down to 360 and my CD4 is around 650 and 26%. My question is that since most people seroconvert without any major symptoms, does it mean anything in the long-term that I had such a horrible acute seroconversion? Does it mean that I might have a more aggressive (more replicative) virus? It was mentioned when I started meds that I might could come off them once I got under control but from what I have read on here it would be pretty risky to do that would you agree?

Response from Dr. DeJesus

Very interesting question. There are some viral infections in which the severity of the acute disease correlates with the degree of immunity. For example, for adults infected with HBV, the severity of the initial infection correlates in most part with the degree of immunity.

The same correlation has not been established with HIV, although some experts have observed strong immunologic responses in some patients with a rather symptomatic severe primary HIV infection. One thing that we can say for sure is that there is no correlation between the severity of your HIV seroconversion and the replicative capacity of the virus.

Treatment after acute seroconversion has been theorized to be beneficial in preserving HIV specific immune functions. For the most part, in patient that discontinue ARV medications after treatment of the acute seroconversion there is a rebound of viral load requiring resumption of therapy. In a few patients viral suppression after initial treatment have persisted without antiretroviral therapy, suggesting that the immunologic improvement during this acutely treated phase was sufficient to restrain HIV replication.

So, we cannot conclude that neither your severe acute HIV seroconversion will results in a better immunological response against HIV, nor that interruption of your treatment now will maintain virologic suppression.

My recommendation: if you are not having any problems taking your current regimen and your adherence to it is optimal, then continue this treatment without interruption, because there is probably more to loose than to gain by stopping your treatment now. Good luck!



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