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Acute Infection? and IL-2
Aug 30, 2000

I tested hiv positive on May 24 2000. The first test showed the elisa+ but the western blot -- indeterminate(p24 reactive). Two weeks later I took the test again with a cd4 and viral load count and the same thing happened: elisa+ and western blot indeterminate with p24 and gp120/160 reactive (vl= 1.4 million and cd4=357). I started HAART at the beginning of June with Sustiva and Combivir. At the one month follow up (July) I had really good results. My viral load had dropped to 1,297 and cd4 went up to 479. I have been reading a lot on HAART and acute infection and I thought that it would take much longer to get theses kind of results. My questions are: Do you think that I could have been in acute infection (my viral load being so high) and had not developed all the antibodies yet but developed them during my first month of HAART? (I honestly do not know when i would have been infected) Also do you think that the reason I did so well on the medicine was because of my age? (I am 19yrs) Another question that I have is what are the chances that I would reach undetectable by the next time I go see the doctor which is in November? I have also been reading about IL-2 and immune based therapies and have read that on HAART your cd4 count rises an average of about 110. I have reached that number but do you think that my t-cells could rise even higher or have I already reached my max? Also, what are your thoughts about IL-2 treatments at this point? Thanks for your help.

Response from Dr. Stryker

Were you in the acute phase of infection in May/June? This is often difficult to determine in the absence of a clear clinical history/likely time of infection. But it seems very possible given your indeterminate Western Blot, and impressively high viral load. The good news is that you have had an equally impressive (virologic) response to the treatment. It is very possible, even likely, that you will achieve undetectable status by the time of next labs. However, it can take 12-20 weeks; if you have not gotten undetectable by this point, you should discuss possible treatment changes with your doc.

If you were in the acute phase, then we don't know what your virologic "set point" might have been had you waited on therapy. But that's OK -- the trade-off is that you have started treatment early and may have limited immune damage.

Your CD4+ count may well continue to rise; the biggest increase is in the first few months, but they will often continue to increase with continued viral suppression.

Why did you have such a good response so quickly? Hard to say; if you were in acute infection, as we've said, your viral load may have come down a bit anyway. There are likely some age-related differences in response, with very old folks responding less well. Your age may have been a small factor, but probably not critically.

As for the role of IL-2 in acute infection, it probably doesn't add much, and except in the context of specific research trials does not need to be used.

Best of Luck, and keep sending the good questions! RAS

Rick Stryker, M.D., M.P.H.

Immune-Based Therapy
Sustiva -- Three Single Doses Daily?

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