Prolonged Acute HIV Infection
Sep 25, 2001
I am a 17 year old male that had my first sexual encounter at the end of May 2001. I began to get sick two week later with abdominal pain, sore muscles and feet, and flu like symptoms. At three and a half weeks I developed a temperature of 105 degrees which persisted for 12 days and between 101 to 103 for 10 additional days. I also had diarrhea with blood in my stool, sore throat, fatigue, vomiting. I was hospitalized for 2 and a half weeks, and was told I had extremely high liver enzyme levels, low platelet count, and low WBC count. My HIV test was negative on July 17, 2001. After I was discharged from the hospital I developed very enlarged lymph nodes and a rash on my face and in my hair. My symptoms and illness has continued so I had a second HIV test,which was positive on September 15, 2001. Since then I have had a recurring temperature of 101 to 103, profuse night sweats, and a persisting rash.
Since my initial reaction to infection has lasted better than 2 months and still going, will my progression to AIDS be quicker? I Met with the Doctor on September 17, 2001. He did blood testing, a TB test, and started me on Combivir and Sustiva without knowing my CD4 Count or Viral Load. He offered at my initial office visit that my viral count would be high during this time. Why then would I need to start treatment right away?
What should I be asking the Doctor at this point, and why would he start treatment prior to knowing initial levels or establishing baseline or trends?
I am concerned whether treatment is needed at this point. Is treatment being pursued now or seen to be a good thing to do since I don't seem to be able to get over these symptoms? What is the life expectancy for a person that has an initial reaction as I have with and/or without treatment? Especially an illness that does not abate.
Please provide some advice on what course of action I may want to pursue hereafter. I am afraid and dont know where to turn for help. Your help is greatly appreciated.
Response from Dr. Young
Thanks for your questions.
In the setting of acute HIV infection, viral loads are often very high and not typically representative of the viral load "set point" (or steady state) after the infection is more established. While the timing of the initiation of HIV therapy has become somewhat controversial over the past year, there is agreement that there are substantial benefits to starting therapy during acute infection. These include the preservation of HIV-specific immune responses (an effect that goes away very quickly) and the very real possibility that early treatment may acutally lower the viral load set point during later stages of disease. That is to say that among patients who started HAART during acute infection and subsequently stop therapy, the viral load appears to be much lower than average. A tantilizing few pateints actually have undetectable virus in the blood, suggesting very good immunologic control. This does not mean that the virus is cured, since HIV can still be detected in tissues and cells. Because of these data, we are very aggressive in recommending the early initiation of therapy among persons experiencing acute infection (in the process of seroconversion, or where the antibody test is either negative or indeterminate and where a viral load or viral antigen test is positive). The situation (and recommendation) changes if one is diagnosed positive, but the antibody test and special antibody tests called de-tuned Western blots are fully positive. In this later circumstance, one could rationally follow trends in CD4 cell counts and viral loads.
There is insufficient information about the severity or duration of initial symptoms and the rates of progression to AIDS. More important predictors are the viral load and CD4 count. Most importantly, the response to HAART and absence of drug resistance (either from initial infection or from emergence of resistance during treatment, predicts long-term preservation of immune function and lack of progression to AIDS.
I hope that this information is helpful. Good luck. BY
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