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Newly infected, already on Atripla. Concerned about antibody tests

Feb 10, 2009

Dear Dr. Young/McGowan: I was recently infected in Oct 08. 10-31-08: (VL/CD4) 265K, 921. 11-15-08: 77K, 821. My doc put me on Atripla right away since he adviced that I still had sth to lose & should try to protect the immune system. I was back again 12-11-09: VL/CD4 300/1200, 2-09-09 50/920. My antibody test NEVER turn truly positive. The last time I got tested 11-21-09 there were only 2 weak positive bands. 1. What is my my life expectancy (I'm 28) and my phenotype test came up wild type, non resistant? 2. Should I get another WB test to see if the seroconversion completed its course? How would the results of the tests change my treatment plan? 3. Would I have a slight chance of going off Atripla later on? all my side effects are managable but the drug still greatly influence my life. Moreover, I'm concerned about the long term damages that it would cause for me. 4. Would I ever get a super infection from other strains if I am continuing to be on this drug for the rest of my life? Since I got infected via receiving oral sex, I have been very very anxious about having sex with anybody. My infection was accute and caught so early that the doc was able to narrow down to a few weeks of primary infection Thank you so much for all the great work. PLEASE reply to my questions though they sounded idiotic

Response from Dr. McGowan

I am glad you have done so well. Let's look at your non-idiotic questions: 1) Life expectancy has been increasing every year due to the availability of new drugs to treat HIV. A 20 year old entering care can expect to live close to another 50 years...and this is also improving each year. In France they found that if a person can keep their viral load undetectable for over 5 years and their CD4 count above 500, they can live a normal life span. The key is to keep the virus undetectable and the CD4 count high. 2)There is no need to get another HIV test, the high viral load at conversion confirms your infection, the test would change nothing in your management. 3) You would be able to go off treatment if you wanted, especially since you have undetectable virus. The benefits of early treatment are still being debated. A new study showed a decrease in viral load after early treatment once treatment was stopped. The trade-off is treatment now vs treatment sooner in the future...See how you feel and make the decision as time goes by. Most people do not develop long-term side effects on Atripla. The benefits of successful treatment is keeping virus suppressed and immune activation low, which may be the most important thing in stopping disease progression. 4)You could always get a superinfection, regardless of the treatment (in fact being on treatment might lower your chances). Recent data suggested that the superinfection rate is about 10%. The way to avoid that is to use condoms during sex.

Good luck, Joe


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