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Jan 9, 2002

Would you recommend early treatment 8/9 weeks after exposure. With CDT4 at 690 (50). Viral load not available yet, with following DT4, 3TC, Abacavir for 6 months, and than reevaluation of possible changing therapy.

Response from Dr. Pavia

If I read your question correctly, you know that you are infected, and it has only been 8-9 weeks since you were exposed. Because you say you don't have the viral load back, I am concerned that you be absolutely sure that all of the tests necessary to prove infection have been drawn before starting therapy. For instance, if you had symptoms and either a positive DNA PCR or p24, it makes sense to draw a viral load and then start treatment, so you will have at least two positive tests.

Most of us still are reasonably enthusiastic about treatment early in primary infection, for reasons reviewed on this forum before. This largely relates to the work of Eric Rosenberg and Bruce Walker, confirmed by a European group, that suggests that early treatment may let you go off therapy later with better immune control. However, remember this is still in flux and may change over time, as so many things do in science. Another way of looking at it is, would most HIV docs start therapy if diagnosed 8 weeks after the exposure? You bet.

There is no real data to decide what the best regimen is in this setting. d4t, 3TC and abacavir is attractive and easy to take, but may not be best if your viral load is really really high. Whatever regimen you go on should be one you like and tolerate, and should be potent enough to get your viral load below 50 copies.

We don't yet know when to reconsider, but there is a lot of research going on. In fact, if you can enroll in a study of acute primary infection, it may be the best way to stay informed and educated. Good luck


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