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thrush during acute viral stage

Aug 4, 2001

Dear Doctors,

I have posted this questions several times without an answer.

Assume a person is HIV positive after an exposure two months ago. Only acute viral syndrome symptom was thrush(no fever, rash, or other common symptoms). Is this common based on your experience- to have thrush without other severe symptoms.

Is it still recommded to start treatment for HIV with the full cocktail regimen when thrush exists during the acute viral stage(or beginning of the HIV progression), even though the tcell count is above 350 and viral count is within a reasonable range?

Or, is thrush during the acute viral stage an indication that the disease is very rapidly progressing and that body(immune system) could already be severly damaged enough to have a very low tcell count(perhaps below 350) after only two months of infection.

I am confused- please help

Response from Dr. Aberg

People may or may not have any signs or symptoms when they first get HIV. In some series, up to 10% of individuals may have thrush when they first contract HIV. I cannot give you a more precise percent of individuals who only have thrush.

There are some thoughts that the "sicker" you are when you first get HIV, then the more likely it is that you will have a more rapid progression of disease. This is based on that the HIV viral load is usually higher in patients with lots of symptoms. However, remember that I said some people do not get any symptoms or signs so therefore we do not know what their viral loads were when they got HIV. Lots of unknowns.

As far as therapy, there are debates about whether individuals with pimary HIV should start on therapy. One thought is that if you start antiretroviral therapy immediately, you may help the person's immune system fight HIV naturally. The question remains how soon should you start. Does it have to be within a week, several weeks, months or a year? If you start therapy, do you need to stay on therapy for life? Can you take therapy for a few months, a year or two years and then stop? So, again, all these unknowns. It is best to see a HIV expert and talk about what the various options are. I encourage anyone with primary HV to see if they qualify for a clinical trial so we can learn more about this disease and find out what is the best management of early infection.

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