Aa
start antiretroviral therapy or not?
Hello, I am 25 years old and HIV positive since Aug 2012. The infection has been detected during the first weeks of a primary infection. I had flu like symptoms for almost a month and had other symptoms as well. My first test results were: CD4+ slightly above 800 and viral load above 1,000,000, after two months (in late October) CD4+ decreased to 570 and viral load is still stubbornly high at 760,000. I feel quite good, sometimes I have a soar throat and the lymph nodes are still swallen (only on my neck though it does not hurt). I would like to know whether I should start with the treatment already or wait? What are the pros and cons of starting the therapy now? Do you think that such a high level of the viral load after 3 months after infection could mean the infection will progress faster or? My doctor told me there is actually no consensus whether to start the therapy once infection is detected during this first stage. Thank you for your answer in advance!
MEDICAL PROFESSIONAL
Welcome to this newly established forum. Thanks for your question. I'm sorry to hear of your new HIV infection -- but glad to hear you are under care and seem to have an objective perspective about your treatment.
Your doctor is correct that not all experts agree on when to start treatment is indicated in cases like yours. However, the consensus is definitely moving toward earlier treatment. Although it's a bit soon to know your viral load "set point" -- i.e. where it will settle a few months after infection -- the number so far suggest it's likely to be rather high. As you suggest, that indeed suggests a possibility of fairly rapid progression of immune deficiency. Also, the definite threshold for treatment (in industrialized countries) is a CD4 count of 500, and you'll probably go below that level in a matter of months. According to the highly respected CASCADE study from Europe, on average, CD4 declines to 500 about a year after catching HIV, and you're already getting close. See the link below.
http://www.ctu.mrc.ac.uk/cascade/
Other factors to consider are whether you have other conditions that may affect prognosis (hepatitis B or C, substance abuse, etc) or protection of partners. People on therapy are far less likely to transmit the infection to partners than untreated patients are.
So all things considered, in my opinion you should be on treatment very soon. However, your doctor may well be equally or more expert in HIV management than I am. You don't say whether s/he is an infectious diseases specialist or otherwise highly experienced in the management of patients with HIV. If not, a second opinion would be a good idea. At a minimum, discuss my perspective with your doctor -- perhaps by printing out this thread as a framework for discussion.
I hope this has been helpful. I'll be interested to know what decision you and your doctor come to.
Best regards-- HHH, MD
Your doctor is correct that not all experts agree on when to start treatment is indicated in cases like yours. However, the consensus is definitely moving toward earlier treatment. Although it's a bit soon to know your viral load "set point" -- i.e. where it will settle a few months after infection -- the number so far suggest it's likely to be rather high. As you suggest, that indeed suggests a possibility of fairly rapid progression of immune deficiency. Also, the definite threshold for treatment (in industrialized countries) is a CD4 count of 500, and you'll probably go below that level in a matter of months. According to the highly respected CASCADE study from Europe, on average, CD4 declines to 500 about a year after catching HIV, and you're already getting close. See the link below.
http://www.ctu.mrc.ac.uk/cascade/
Other factors to consider are whether you have other conditions that may affect prognosis (hepatitis B or C, substance abuse, etc) or protection of partners. People on therapy are far less likely to transmit the infection to partners than untreated patients are.
So all things considered, in my opinion you should be on treatment very soon. However, your doctor may well be equally or more expert in HIV management than I am. You don't say whether s/he is an infectious diseases specialist or otherwise highly experienced in the management of patients with HIV. If not, a second opinion would be a good idea. At a minimum, discuss my perspective with your doctor -- perhaps by printing out this thread as a framework for discussion.
I hope this has been helpful. I'll be interested to know what decision you and your doctor come to.
Best regards-- HHH, MD
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