When Should HIV Treatment Begin?

Dateline: 09/24/98

The commonly accepted "doctrine" for treatment of HIV is to begin immediately. Most physicians will start treatment of HIV when the person is initially diagnosed regardless of the time of initial infection. However, Dr. Jay Levy, one of the initial discoverers of the HIV virus, suggests that starting immediately, in certain cases, may do more harm than good.

The traditional and preferred treatment has consisted of the highest medically possible dose of a combination of drugs commonly known as the AIDS drug cocktail. Current thinking suggests that keeping the virus "in check" is the best option.

Dr. Levy's research focused on patients who had been infected with the HIV virus for several months or several years. Both sides agree that starting the antiviral therapy immediately is best if the person was recently infected or is in the acute stages of infection. Immediate treatment allows for the marked reduction of the viral levels in the body of a recently infected patient and may assist the person's immune system in combating the initial infection.

However, for people who are in relatively good health and have been infected with the virus over a period of several months or years, treatment with the antiviral medications may actually inhibit the immune system leading to adverse consequences.

Dr. Levy's primary concern is the efficacy of the timing of the treatment and not the efficacy of the treatment itself. He suggests that physicians reconsider when to start treatment for those people past the initial infection period. By starting the treatment too early, the person may have to be on the treatment for life. Likewise, the effectiveness of the cocktail may be curtailed earlier as the virus develops resistance.

He also notes that subjecting people to the drug cocktail when the immune system is functioning almost normally may impair the ability of the immune system to fight the virus in the later years of infection. If the cocktail is discontinued once started, in almost all cases, viral production continues at a rate above that when the treatment was first started.

Levy suggests that after primary infection, the treatment be begun only after the level of CD-4 cells drops below 400 or the level of copies of the virus approaches 30,000 (per ml of blood).

What do you think? Are there more effective methods for timing the treatment of HIV patients? Come over to the Biology Forum and share your thoughts, opinions, and feelings.