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fourth try, rural doctor
Dec 5, 2001

I've asked these questions in all relevant forums many times with no answer. Please try and help as I'm desperate.

I will try to make this short.

I realize it is possible to get Oral thrush during the acute stage, but that generally it presents itself during the advanced stages of HIV.

Does oral thrush during the acute stage with a relatively healthy person before infection, mean that a persons immune reserve is not strong enough and has dropped to a level of 350cd4 within 2 to four weeks of infection with HIV?

Is it possible in otherwise healthy individuals, for the disease to progress so far(cd4 below 350) in only one or two months? What are potential "catalysts" for rapid disease progression.

Do we still have to administer haart and prophylaxis even though oral thrush presented itself during only the acute stage?

thank you.

Response from Dr. Young

To my knowledge, the presence of thrush during acute infection does not have any significant prognostic value towards one's viral load setpoint nor CD4 count after the acute phase has resolved. The decision to initiate HAART or OI prophylaxis should be made on the basis of the CD4 cell count after the acute phase is over (i.e., during established infection).

As for what determines rapid CD4 cell decline, it is known that the amount of virus (viral load) is a significant factor in the rate. It is also thought that certain phenotypic strains of HIV, syncitium forming virus, causes more rapid CD4 cell decline.

We have also recently appreciated that some co-infections, particularly tuberculosis and hepatitis C accelerate the pathology of HIV infection. /BY



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