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Worth Starting Treatment Earlier to Lower Transmission Risk?
Jan 5, 2008

Hi Dr. Bob,

I'm an HIV positive man and I just began a relationship with a guy who is negative. He has been wonderful and accepting of me. I've been poz for over two years and am not currently on treatment. My latest few labs show my CD4 in the low normal range (400-500) with a viral load of 20-30 thousand. Going by the general trend in my labs I would estimate that it will probably be another one to maybe three years before I need to start ARV therapy anyway, but(in your opinion)is starting treatment early to reduce transmission risk worth the long term side effects? By the way, I have no drug resistance and achieved an undetectable viral load while on Kaletra/Truvada for 6-8 months following my early diagnosis. I would describe the side effects as manageable, mostly just a sensitive GI tract and very mild fatigue. Thanks for all your help!

Response from Dr. Frascino

Hi,

Is starting treatment early to reduce transmission risk worth the potential long-term side effects of antiretroviral drug therapy? Excellent question! Unfortunately I have a less than excellent answer. We honestly don't know! Certainly some magnetic couples have adopted this harm-reduction strategy. However, since most antiretrovirals currently in use are relatively new, we really don't have good long-term safety data yet. Also, even driving one's HIV plasma viral load to undetectable levels doesn't absolutely guarantee transmission won't occur. We know it significantly reduces the potential for HIV transmission, but it doesn't completely eliminate it. Consequently condoms are obviously still your first line of defense. So should you start therapy earlier or not? Only you can answer that question. Talk it over with your new Mr. Right and your HIV specialist. Ultimately you have the final say in this decision. I can tell you there is at least sound scientific reasoning for considering this option.

Good luck to both you and your new stud muffin. I'm wishing you a "happily-ever-after" life.

Dr. Bob



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