HIV Digest	HIV Digest Archive

Some researchers at the recent 12th Conference on Retroviruses and Opportunistic Infections in Boston have advocated that highly active antiretroviral therapy (HAART) should be offered to all patients who are identified during the first few months following their acquisition of HIV infection. Their reasons were as follows: 1) During acute infection, the viral reservoirs have not yet been completely established, and early therapy will interrupt this process; 2) A patient's immune system during acute infection is still largely intact, and it is likelier to remain so with HAART; 3) At the time of acute infection, the viral isolates are still quite oligoclonal and more amenable to control by a patient's immune system; intervention with HAART (before significant viral diversification occurs) may perpetuate this state.

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However, there could be significant consequences to this approach. In addition to the simple inconvenience of having to take pills every day, there is always the risk of short-term and long-term toxicity. Perhaps, more importantly, with treatment there is the risk of developing drug resistance and, as a result, limiting future therapeutic options.

The final plenary of the conference on Retroviruses and Opportunistic Infections was entitled "Making Sense of HIV Pathogenesis." In it, Daniel Douek, Human Immunology Section Chief at the Vaccine Research Center of the National Institute of Allergy and Infectious Diseases, presented convincing evidence that HIV itself, either directly or indirectly, causes the loss of CD4+ cells and other damage that ultimately leads to AIDS. More interestingly, Douek showed data to support the theory that a significant proportion of CD4+ cell loss occurs at the earliest stage of disease: during acute infection.

In the gastrointestinal tract, for instance, there is virtually a complete loss of lymph tissue during acute infection due to the extensive destruction of CD4+ cells, and the body never fully recovers from this loss. This finding adds to evidence that suggests that, if you intervene with HIV treatment during acute infection, this loss of lymph tissue can be prevented from occurring, perhaps forever. Although this study does not provide conclusive evidence regarding the use of HAART in this setting, it certainly bolsters the rationale for a careful trial to be performed to resolve this issue once and for all.

Editor's Note: from www.thebodypro.com