Nov 6, 2006
What benefits, if any, do you expect from treating "old HIV". I'm assuming people who've gotten infected recently have newer mutations with various resistances, etc. I'm a long-term-non-progressor, and probably was infected about 25 years ago. I have not been in any situations which would have re-exposed me to additional HIV. As my CD4s are slowly but surely bottoming out, whenever I start meds, do I have any higher likelihood of response and success? Would you approach what you prescribe any differently for me, perhaps fewer drugs than "today's infectees"? Or does the age of my HIV not really matter? (My VL has never been higher than 54 and has been undetectable since '99).
Also, if someone's CD4 goes <200 but has relatively-high percentages, would their treatment be approached any differently than someone who was, say, 140/13%? (And let's assume no VL in each case).
Response from Dr. Conway
Someone who is a long-term non-progessor has defined him or herself as someone whose immune system is able to keep the virus under control quite efficiently without the use of antiviral drugs. This being said, at some point this control may be lost and I would use the same criterion I use to recommend the initiation of treatment as I use in more recently infected individuals. If the CD4 count approaches 350 or if it is decreasing quite rapidly, I recommend treatment. I would always go with a once a day regimen, and I really like the single Atripla pill (containing 3 drugs), as long as the Sustiva component of it is not a problem for the person.
To address your two other questions, if the CD4 count is below 200 and the percentage is still high (say 16% or more) I would still start treatment unless there is a severe acute illness that could have decreased the CD4 count artificially. I would then make sure it goes up after the illness passes.
As for a different regimen in more recently infected individuals, I do not do this as our primary resistance rates are quite low. To be safe, however, if primary resistance is a concern, we may recommend that a resistance test be done before the treatment is selected.
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