Treatment with antiviral drugs for HIV infection that begins too early can work against the patient's natural immune system and do more harm than good, says a pioneer AIDS researcher at the University of California San Francisco.
In a "viewpoint" piece in the September 19 issue of Lancet, Jay A. Levy, MD, a UCSF professor of medicine and one of the first to discover HIV, outlines his concerns about the current strategy advocated by the clinical community for prescribing combination drug therapy, often called the AIDS drug cocktail. His article is titled, "Caution: Should We Be Treating HIV Infection Early"
Levy's research has focused on natural immune response against the AIDS virus. The accepted treatment guideline, Levy says, is to begin therapy "as soon as possible and with as large an armamentarium as is available." He emphasizes that his concern is not about the treatment itself but is about the stage at which it is initiated.
"Physicians should carefully consider the time when drug therapy is begun for infected individuals who are past the acute infection phase," he writes. "Until we have a good surrogate marker presaging irreversible damage to the immune system or a means of inducing an anti-HIV immune response, a delay in initiating therapy should be considered."
In his view, he writes, "treatment with antiviral drugs starts the clock ticking too soon, limiting future options and making therapy a necessity for the lifetime of the person."
He adds, "Any decision to stop the drugs could only be made if one had assurances that all infected cells had been eliminated--now an unlikely event--or the immune system has recovered sufficiently to control HIV."
Levy supports therapy during acute or primary infection, noting that "within
days after the virus enters the body, a major benefit to the newly infected
individual can be provided by lowering the viral load dramatically and perhaps
even arresting the establishment of HIV infection
Contact: Corinna Kaarlela
University of California - San Francisco