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why not start meds immed?
Oct 7, 2007

i don't understand why patients are advised to wait to start hiv meds? what is the rationale behind waiting until your viral load is high and t cells are low? why not just suppress the virus immed?

Response from Dr. Daar

Great question!!

The history of this issues goes back to the availability of protease inhibitors. At that time (approximately 1996) we realized that many people could suppress their viral load to undetectable levels and do very well. Unfortunately, we also learned that many did not suppress virus completely and developed signficant side effects of therapy, drug resistance and found themselves with limited treatment options. Because of these concerns and the realization that many people remain asymptomatic with HIV for many years, the recommendations tended to suggest starting therapy when there was a substantial risk for developing complications of AIDS, such as when CD4 cells were less than 200 cells/uL.

While the above outlines the reasons to consider delaying the initiation of therapy the reality is that much has changed since then. Currently therapy is much more effective, better tolerated and even when resistance develops leaves many treatment options. For these reasons many in the field are asking the same question you asked and revisiting the issues surrounding when to start therapy.

From my perspective, the best time to start anti HIV meds is when the patient is ready, willing and able to commit to treatment. That said, there is rarely any urgency to start and there is usually plenty of time for a provider and patient to fully discuss the pros and cons of early treatment in the current era.

Best, Eric


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