Response from Dr. Sherer
The answer to this simple and important question has proven elusive. The honest answer is, we still don't know. A corollary answer is that we have not been able to prove that the benefits of early therapy outweigh the risks to date. For these reasons, this question is still a matter of active research, and someone who believes that they may have recently been infected would do well to enroll in one of the many clinical trials of early therapy in the US in order to contribute to gathering the data that will help to answer this question. The relevant 800 number for this type of research question is 1-800-TRIALSA.
From the data that is avaialable, it appears that SOME patients -as many as a third of patients - with early HIV infection do have some preservation of immune function, such as the viability and activity of niave CD4 memory cells, when ART is provided early.
Unfortunately, there appears to be no such immunologic benefit in the majority of patients treated early, and another significant fraction - again, about one third - seem to do worse with early treatment.
There are a few clear indiciations for early ART. The most obvious is the setting where HIV is causing an acute clinical illneess such as encephalitis or severe constitutional symptoms like fever, sweats, and weight loss. Another is a major AIDS-related opportunistic infection such as PCP pneumonia; though these are quite uncommon, their occurrence is an indication for prompt ART.
The current HHS Guidelines has an extensive discussion of the possible advantages and disadvantages of early therapy in acute HIV infection, as well as the possible advantages and disadvantages of delayed therapy. These can be accessed at www.AIDSinfo.nih.gov
For the asymptomatic patient with evidence of early HIV infection, the best practice would be to enroll in a clinical trial of early HIV infection. Anyone in this situation should contact their doctor promptly for their advice and for referral to such trials.
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