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Re: Newly Infected
Oct 4, 2001

Dr Young, You said that during the acute period, early treatment may minimize the possibility of drug resistance.

I have never heard this before. Could you elaborate a little this subject?

Response from Dr. Young

Thanks for your question.

This issue is mostly theoretical, but stems from two areas of research. We do know that the genetic diversity of HIV during acute infection is lower than during established, or chronic infection (this is known as an evolutionary bottleneck). Because of this, the presence of minor populations of virus that might be drug resistant are less likely to be present. Since the presence of low-level resistance often sets the stage for higher level of drug resistance, treatment during acute infection may avoid this potential for genetic diversity and drug resistance.

Additionally, during acute infection, drug susceptibility testing (genotype or phenotype) is especially able to detect drug resistant virus. Recall that as many as 10-15% of new cases of HIV may have some evidence of drug resistance (data presented by Little at this year's Retrovirus Conference). Hence, the ability to select a drug regimen that is most potent (and appropriate) for an individual may be enhanced by susceptibility testing during acute infection. It might be argued, too that early initiation of treatment with such a regimen would be more likely to be effective, based on the previous comment.

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