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IF Diagnosed early/When to start treatment
May 1, 2001

I am awaiting my test to determine if I am HIV+. I had a sexual encounter with HIV+ person of 3/31/01 and experienced Fever, Swollen Glands, Fatigue for past 2-4 weeks. I will get the results 5/4/01. The date of possible exposure was March 31, 2001. If positive what is the best course of action for me? Would it be wise to get involved in early treatment to try to get a quick handle of the virus? I wnat to live a long life and see my kids grow up along with my wife and want to be prepared to quickly make the right decisions on how to handle the virus (if positive).

Thank yoy in advance for your quick response

Response from Dr. Cohen

The short answer is that yes, there is some reasoning to consider treatment as soon as you know.

There is work currently being done at several major research centers in a few cities such as Boston here in the US and elsewhere defining the potential benefits of initiating treatment. What has generally been noted is that there are a population of cells in our immune system that may have the ability to control HIV infection. If they survive the initial battle between HIV and the immune system, then the viral load may stay low for years to come, delaying the need for antiviral treatment. However, if these cells do not survive in sufficient numbers, there can be a higher viral load and more rapid destruction of the immune system.

And we have learned that one way to help these cells survive this battle is to initiate treatment during the initial battle - in the first few weeks to months after infection has happened. You are certainly within this window of opportunity, if HIV infection is confirmed. Note that treatment can be initiated based not on the HIV antibody test, but on a test of HIV viral load - since the first sign of HIV infection is actually a high viral load, followed soon after by positive antibody tests as seen on a standard "HIV test".

You can also just monitor and delay treatment. There are some who emerge from this initial battle of HIV and the immune system and do well for years to come without need for antivirals. The reason there is more enthusiasm for very early treatment is that, based on initial results, it may turn out that those who do so have an increased ability to one day come off treatment entirely for prolonged periods of time. Now, this may also be true for those who do not start treatment early on, but the research done so far suggests that those who do start early have preserved the ability to control HIV - which is harder to restore once lost.

We have reviewed this issue here several times - and you may find that browsing other answers is helpful to you. In addition there are some conference summaries on this site that have also reviewed this information in more detail.

However - perhaps all of your tests will be negative and this episode will just be a powerful reminder to be even safer next time...



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