I was recently diagnosed My baseline CD4 was 348; viral load was 41,000. I am not yet on meds and am waiting results of my second reading. Overall I feel very good but do have some leukoplakia. My doctor has said it will go away when I do go on meds. Is this true? We are leaning toward a protease inhibitor-sparing regimen to start with. Also, beyond meds, is there anything that can be done for the leukoplakia that can lessen its appearance?

Optimizing oral health and treating any thrush or local epstein-barr virus (EBV) can often help clear up oral hairy leukoplakia. The SMART study is enrolling pxs through the US with CD4 count > 350 into 2 different treatment strategies--1) treat now and continuously and 2) wait until CD4 is < 250 and then treat unitl CD4 >> 350 and then stop for a while. I favor use of resistance testing up front to help guide my choice of starting meds and I favor use of a ritonavir boosted PI initially (to avoid resistance) until the viral load is undetectable. Then there are many choices to simplify the regimen based on patient preferences and characteristics. KH