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Early Meds
Nov 27, 2009

I've been reading many posts on this site and other places. I see where many knew exactly when they were infected and were put on meds, because their CD-4s had dropped and VLs gone way up.

Isn't it normal for this to happen during sero-conversion? I'm sure all of us HIVers had really low CD-4s and high VL right after infection. I'm not on meds yet and think I've been infected for 7 or 8 years.

Are you seeing more doctors starting patients on meds right after infection? I'm thankful I found out before my immune system got bad. I know many find out they are poz after they get PCP-pneumonia and have like 5 T-cells.

It is so confusing why some docs would start meds immediately after infection and others want to wait for the CD-4 350 guideline. I'm reading so much that an HIVer can look so healthy on paper, because CD-4 staying very high with low viral load not on meds. However, HIV can be causing severe damage to the immune system and we can be getting a false sense of security.

Are we putting off starting meds for good reasons--especially when some are starting right after infection? I keep hearing experts say new meds are very tolerable and safe.

Is it just too early to have research into pros and cons? I know we and our docs want to make the right call. I'd hate to hear 5 years from now that we should have started meds right away.

Thank you all for all you do!

Response from Dr. McGowan

Thanks for the post. You have hit on a couple of areas where there is no complete consensus on treatment, so that is why it is variable.

The first is treatment after infection....this may be different then what you think. Most people do not get diagnosed in the very earliest time after infection....that is, in the seroconversion period. This is in the first few weeks of the infection. Sometimes HIV can be diagnosed even before the standard blood tests are positive. There are some docs who feel that starting treatment at these very early times is important to "preserve" the immune system from initial damage and allow it to attack HIV more strongly. But some data imply that even this may not be soon enough to stop the damage and that treatment may not add any early benefit. So that is controversial. There are some clinical trials going on to help answer this question...notably at the Aaron Diamond Research Institute in New York.

The other part of your question applies to most people. After the first couple of weeks of infection when things have settled down, when is the best time to start treatment? Right now guidelines say to start around 350 CD4 cells. Some data suggest 500 may be better (but other studies do not). It depends on your beliefs about the virus and taking meds. There is also a clinical trial called the START study which is hoping to answer this question. Most docs will individualize treatment. If someone has 500, 600, or 800 CD4s and wants to start treatment, most docs would agree and work with them. I think the more we learn about what HIV does when it is left unchecked, the more we will realize how important it is to keep it suppressed.

Best,

Joe



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