How is early symptomatic HIV infection treated?

Updated: Jan 02, 2019
  • Author: Robert J Carpenter, DO, AAHIVS, FACP; Chief Editor: John Bartlett, MD  more...
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Answer

Answer

Antiretroviral treatment of acute human immunodeficiency virus (HIV) infection is controversial. However, treating acute HIV infection has several theoretical advantages, as follows [1] :

  • To relieve symptoms in some symptomatic patients

  • To halt viral evolution at a time of minimal viral diversity, prior to viral adaptations to specific host immune responses

  • To protect developing immune responses from the deleterious effects of sustained HIV viremia

  • To reduce the viral set-point

  • To limit the latent pool of infection

Several studies have shown no benefit for short-term combination antiretroviral therapy during acute infection. [8] However, a 2006 retrospective study found that an initiation of combination therapy within 2 weeks of HIV seroconversion was associated with sustained viral load and CD4 cell count benefits for up to 72 weeks after termination of therapy. [9]

In 2007, another group found that in patients who received 3 months of antiretroviral therapy, the subsequent CD4 cell count decline over 3 years was slower than in patients who did not receive acute therapy. [10] When antiretroviral therapy was started later than 2 weeks after antibody seroconversion, however, patients had a persistent but decreasing CD4 T cell count benefit and a loss of the viral load benefit by week 72 after discontinuation of treatment.

CD4 cell counts appear to deplete very rapidly during acute HIV infection. Thus, treatment to prevent early loss of cells may be impractical in most circumstances.


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