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Treatment of acute HIV infection: potential benefits of early antiretroviral therapy
Feb 5, 2015 by David Moore, Physician Lead, STOP HIV, Provincial Health Services Authority
Since 2009, BCCDC has been using a more sensitive HIV test (known as the NAAT - nucleic acid amplification test) for patients who present for HIV testing at several clinics in downtown Vancouver.
These clinics - the BCCDC clinic on Bute Street, the Health Initiative for Men clinics on Davie and Commercial Drive, and Spectrum Health - primarily serve gay and bisexual men and historically have had high rates of new positive HIV diagnoses. The addition of the NAAT test has allowed clinicians at these clinics to diagnose many more infections that are in an “acute” or very early stage of the disease, typically within two weeks after infection has occurred. (Note that more routine HIV tests can also sometimes identify individuals who are in the acute stage of infection.)
Summary of evidence
When individuals first acquire HIV, their viral load (the amount of virus in their blood) increases to very high levels for several weeks. While this early increase in viral load does not usually lead to serious damage to the immune system (measured by the CD4 cell count in the blood), it may be accompanied by many non-specific symptoms including fever, diarrhea, sore throat, body aches and other symptoms. These symptoms disappear within a few weeks as the viral load decreases and the infection enters the chronic phase.
Recently there has been increased interest in trying to diagnose and treat HIV earlier in the course of the infection. This is both to improve clinical outcomes for individuals with HIV, and to better prevent HIV transmission by newly infected individuals.
The clinical benefits for early treatment are not clear, but treatment may help to reduce the length of time that patients feel ill from acute HIV.
Research has shown that large volumes of immune function cells lining the stomach and intestines are destroyed within the first few weeks of infection. This loss of immune tissue may later cause reductions in immune function as HIV progresses. Some small studies have suggested that very early HIV treatment can reduce much of this immune tissue destruction.
Other small studies have suggested that early treatment of acute infection may help some people control their infection without medication. Again the research on this is not definitive and more evidence is needed to determine whether this effect is truly a result of early treatment.
Implications for practice
Given that there may be some benefit to early treatment of acute HIV infection and few (if any) anticipated harms from offering early treatment, some physicians at the St. Paul’s Hospital Immunodeficiency Clinic (IDC) and at Spectrum Health are now providing immediate treatment for patients with acute HIV.
It is hoped that by comparing the clinical outcomes of individuals who are treated very early in their infection, we may better understand whether such rapid treatment pathways are truly beneficial for people living with HIV.
Categories: New knowledge