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Starting early or waiting
Nov 29, 2008

Hi

I was diagnosed about two months after seroconversion. I know because I had two days and nights where I felt awful. I am not on medications as of yet. I wanted to know if I should have started medications then? I've been reading alot about those finding out early they are positive and starting treatment earlier do better. Please explain as my MD said it was to early to start medications.

Response from Dr. DeJesus

The benefits of initiation of therapy shortly after seroconversion are not clear. From the disease progression stand point it appears logic that anyone with detectable virus, regardless of the time of infection, should be on medications. Also from the epidemiological point of view, we would like everyone with detectable virus to be suppressed on HIV meds, to reduce the chances of transmission to others.

One of the main arguments against early initiation is that there are no enough data, collected on long-term trials documenting the clinical benefits of early initiation of HIV therapy (PLEASE read carefully: it is not that there are no potential benefits of starting early, ...what I am saying is that, IF there are benefits, clinical trials have not been conducted to document it).

One thing we know for sure: we can not cure HIV infection by early initiation of therapy; we just can control further progression of the infection. That by itself should be enough to persuade anyone to start therapy (it will do it for me) given that there are data demonstrating that the higher the CD4 count at the start of initiation of therapy, the more normal range those CD4 counts are able to achieve and stay over time.

Another argument against early initiation of therapy is the potential for long term toxicity from the medications. Today we can perhaps argue that the new drugs we have available appears to be safe enough making this argument less relevant.



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