Potential Benefits of Treatment During Early HIV Infection

Preliminary data indicate that treatment of early HIV infection with combination ART improves laboratory markers of disease progression. The data, though limited, indicate that treatment of early HIV infection may also decrease the severity of acute disease; lower the viral set point,18-20 which can affect disease progression rates in the event therapy is stopped reduce the size of the viral reservoir and decrease the rate of viral mutation by suppressing viral replication and preserving immune function. Because early HIV infection often is associated with high viral loads and increased infectiousness and ART use by HIV-infected individuals reduces transmission to discordant sexual partners, treatment during this stage of infection is expected to substantially reduce the risk of HIV transmission. In addition, although data are limited and the clinical relevance unclear, the profound loss of gastrointestinal lymphoid tissue that occurs during the first weeks of infection may be mitigated by initiating ART during early HIV infection. Many of the potential benefits described above may be more likely to occur with treatment of acute infection, but they also may occur if treatment is initiated during recent HIV infection.