Sep 7, 2001
I tested positive in Feb 2001. My viral load was 56,000+ and my T-Cell was 750-799. My Dr/PA began me on a triple combo of Crixivan, Retrovir, and Epivir (Indinivir, AZT, and ?) When last checked in Aug 2001 my Viral load was <50 and my T-Cell was 1200+. I am glad for the remarkable improvements. When I was initially tested the Elisa was pos. and the Western Blot was indeterminate 2X in the first month, indicating a recent infection/and possibly in the sero-conversion stage. I have since tested pos. on the antibody test. Anyway, I do not like the side effects of the medications and have asked the PA about going off them for a short period of time to see what happens. Isn't it probable that my numbers would have stabalized/improved after the recent infection/sero-conversion anyway. If I had more thorough/informed medical advise/treatment, I may have elected to delay beginning medications initially, until we observed what happened. I am being treated by a Native American Health Organization, because I do not currently have private insurance, and while I appreciate the care and medications I am able to access, the level of expertise is woefully inadequate and certainly not on the cutting edge. I am currently in a rural area also. I would like to see what good nutrition, exercise, vitamin supplements, spiritual support/strength, and my own bodies strength/immune system could do without taking/and depending so heavily on the medications, and that is all (the medication), my PA and Health Care professionals want to utilize on my behalf(the medications). I know this is a long question. I am a non-smoker/non-alcoholic consumer, 40years old male, otherwise in excellent health, married with a strong support system from wife, and strong "individual" spiritual support system. Please advise your professional opinion and possible options. Thank you.
Response from Dr. Little
Well it does sound like you have received excellent care and you have many of the same questions that many patients and doctors still struggle with - when to start therapy in a recently infected person. While I cannot provide you a definitive answer, I can say that there is an increasing amount of information to suggest that therapy started within the first few months of new HIV infection may provide a better and more sustained immune response (ie more and better improvement) than if the exact same therapy were to be started several months later. Given that you are on the therapy now and doing well without I hope terrible side effects, some (myself included) might suggest that you consider staying on this (or comperable) therapy for at least 1 year. There have been a small number of patients who have been very closely studied who started therapy very early like this and then were able to stop (after at least 1 year of completely suppressive therapy - ie viral load consistently below 50) and then their viral load did not rebound to a level that we would typically expect. These subjects are being followed very closely, but at present, the news if fairly good - they seem to be keeping normal T cells and their viral loads are staying low (typically less than 1000) without restarting therapy for many months.
There is a national study now ongoing to evaluate this kind of treatment/interruption strategy more closely. I do not know any data to tell you that you should stay on therapy given your high T cells, but my bias would still be to stay on until you have toxicity which makes the decision more pressing, you have been suppressed for at least a year and want to try a treatment interruption, or indefinitely - while we wait to learn more about people like yourself.
We are trying hard to learn more (as quickly as possible) so that we can better advise people in your situation, but for now, it really comes down to the same old balance of risks vs. benefits. I personally think that the benefits of therapy outweight the risks for most people AND there is this compelling idea that perhaps people who start therapy early enough may have an option to stop therapy at some point in their course with a much more favorable response than typically seen by those who start therapy with more established infection. I am not advocating that you stop in a year - but you may want to continue your education and read whatever you can on this topic over the next year to know if it is something you and your doctor want to consider.
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