6 Questions From a Newly HIV Diagnosed Person (Editor's Pick)

Question

Dear Doctor,

Thank you very much indeed for this great forum, your time aaand for putting up with some of our occasionnaly annoying questions (like, when somebody asked whether it is a problem, that he took his medication 3 minutes late)

Im a 40-year-old gay man from Spain, diagnosed in March this year. Otherwise in great health, no smoking, drinking, no drugs, "moderate gym-goer". My HIV cannot be older two years, since my last hiv test was negative in 2013. I read a lot since March, so all these things, such Start study, maturation inhibitors, injectable long-lasting bi-therapy, TAF instead of TDF are already in my vocabulary My questions would be the following: 1.My CD4 went down from 480 to 430 in four months (I know they can vary a lot, within one day as well), but my VL went up from 35000 to 50000. These two changes in 4 months would be reason to worry? I hope to be able to start on Triumeq (and to get a HLA B5701 negative result) in September.

2.If somebody has had an undetectable viral load for a while and is stable, do you think this new approach to go back to bitherapy (maintenance) will be suitable for most non-problematic patients? I refer to these long-lasting-injecteble Cabotegravir study. I would be the first in the queue to get these shots and then will not have to take pills every day.

3.Do you think also that in line with this a Lamivudine+Dolutegravir combination might be possible, without Abacavir, since Abacavir seems to cause this hypersensitivity reaction?

4.In the following years, are more STR to be expceted?

5.I know the virus replicates billions of times a day, but do we know how much it takes for a virus to go through his entire cicle: enter into a cell till leave the cell in form of new viron?

6.Did I read it correctly, that there is a minimum quantity of virus to be able to infect a new person. How can the body cope with a small number of intruders, but not with more of the same?

Thank you very much indeed for your time & answers.

Answer

Hello and thank you for posting from beautiful Spain.

You have learned an excellent HIV-related vocabulary and your questions are sound ones.

  1. The changes in your CD4 count and viral load are not biologically or clinically significant- both sets of values can vary a lot from day to day, especially the later when not on HIV medications. So, no need to worry at all.

2 and 3) Two drug maintenance therapy has shown very good promise in recent investigational studies, particularly those with rilpivirine and either dolutegravir or cabotegravir- these lead to positive expectations of the lamivudine/dolutegravir combo (which is soon to be starting in large clinical trials).

  1. I'd expect additional STRs to come to the market in the future- indeed, the TAF versions of Stribild and Complera will likely be FDA and EMA approved in months to come. If the two drug maintenance studies validate the approach, I'd expect to see these combos in STRs as well.

  2. Regarding the life cycle of HIV, it's been estimated that from initial infection to the production of daughter virus takes about 24 hours.

  3. A controversial point, but the risk of establishing a productive infection is clearly related to the amount of virus one is exposed to (ie., a larger amount of infected body fluids, or a higher viral load in the fluid). One could therefore reason that there is indeed a low level of virus that statistically speaking, is unlikely to produce infection.

Hope that's informative. Best of health to you and feel free to write me back anytime. BY