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latest information for when to start
Jul 21, 2006

Good Day Dr. Daar, My partner and I both have just recently tested positive and our Drs. think we are in the acute HIV phase. While my Dr. suggests waiting to go on medications till a low CD4 count, my partners Dr. suggests the "hit it hard hit fast approach" which means now. Both our CD4 counts are 537 and 524 respectively, with very low viral loads. I am so confused and feel there is a small window of opportunities seeing how we became infected Just two months ago. Should we start now or wait it out? Confused and stressed in Canada

Response from Dr. Daar

Hi Confused and Stressed in Canada,

Unfortunately, your experience with differences in opinion amongst physicians regarding treatment during your stage of HIV infection is not unusual. The reason for this is that we simply do not know the right answer. The background to this is that there is data showing that treatment during the first weeks/months of infection is associated with preservation of potentially important parts of the body's natural immune response to HIV. It is for this reason that very early treatment may represent a once in a life time opportunity. This must be balanced by the fact that there is no compelling data that early treatment changes outcomes or allows for stopping therapy with good viral control in the future, as is hoped. There are many groups actively investigating this area of research.

It is important to note that there are risks associated with starting therapy early, such as side effects and the possible emergence of resistance, although the latter should be unusual if you take the medications consistently. It is also critical that you and your partner know that this debate and discussion is interesting but the most important thing is that regardless of when you start treatment, now or later, if you take the mediations regularly you should do very well for many years.

I hope that helps. Best, Eric


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