Early Initiation of HAART 12 weeks after Exposure
Mar 28, 2014
Hello Dr.Young, First of all I would like to send a personal thank you as I was recently diagnosed mid last year and with the help of your forum and a strong Christian Faith I know that an abundance of living can be achieved if I am adherent to medication and making some lifestyle changes for the better. First of all just to give you a little background I am a 34 year old African-American male who tested negative in January of 2013. My unprotected exposure was May 1 2013 and I tested positive June 25 2013. My initial labs were cd4 373 cd4% 36 and VL 74,000. I entered a clinical research trial sponsored by Gilead Sciences for the effectiveness of Stribild vs The study medication(Elvitegravir 150mg/Cobicistat 150mg/Emtricitabine 200mg/Tenofovir Alafenamide 10mg on Sept 1 2013.The study is blinded so I do not know which regimen I am on until the end of the study in 2016 when the study concludes and unmasked. My recent labs 6 months later are cd4 1189 cd4% 43 and VL Undetectable Praise God!My question is there has been numerous reports recently including the group of French HIV patients known as the VISCONTI cohort, who started antiretroviral therapy (ART) during the earliest stage of infection, so far appear to be controlling the virus after interrupting their treatment. Do you think that since I started HAART 15 Weeks after my exposure I could possibly very well be "functionally cured" also. After my study concludes do you think it would be safe the see if the virus may very well stay dormant because of Early HAART initiation? Also do you see this phenomenon ever at your practice. Thank you so much for assisting me with this Dr.Young and I think I speak for every person who may be newly diagnosed and read your posts we really appreciate your help. Be Blessed, Derek
Response from Dr. Young
Hello Derek and thanks for posting your interesting question.
It is becoming increasingly clear that there are benefits to starting HAART early- just how early to start is debatable as is the question of how early one needs to start to get to the promise of functional cure.
Data presented at this year's CROI conference shows that for the functional cure goal it's clearly better to start HAART even before antibody tests are positive- in this regard, if you started with a fully positive antibody test, this benefit might be attenuated. Other studies, like VISCONTI also show benefit for earlier starts.
Is fifteen weeks too late? I don't think so- but much of this discussion depends on how you define benefit. At a bare minimum, it's my patients who start early after having a positive test who have the highest CD4s and CD4/CD8 ratios, and likely with the lowest risks of HIV-related long-term complications. What's challenging to do (and for such patients, I'm too timid to suggest) is to stop therapy to see what the viral load levels off treatment are. For now, I'm still recommending continuing on treatment and waiting for courage and more scientific data for guidance.
Hope that helps, BY
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