Sixth International Congress Drug Therapy in HIV Infection 17-21 November, 2002 Glasgow, UK

Several issues need to be considered when deciding whether to initiate therapy in a person with asymptomatic HIV infection. Concerns with delaying therapy have included:

• the risk of development of an AIDS defining disease
  
• the possibility that the rate of virological failure (with its resistance-related consequences for future treatment options) is higher in those with higher viral load and/or lower CD4 count prior to therapy, and hence will increase with a delay
  
• the possibility that there may be some irretrievable loss of immune capacity.
  

The potential drawbacks of early therapy initiation include:

• concern over short and long term drug toxicity, including relatively rare but serious clinical events (eg. pancreatitis) and common adverse effects which can affect quality of life
  
• the possibility that the rate of virological failure in people initiating therapy now is higher than it will be in the future as better drugs become available and further progress is made on optimal monitoring and adherence maintenance.
  

Data from observational cohorts have been used to provide evidence concerning all these issues. Such data will be reviewed and conclusions drawn.

Presenting author: Andrew Phillips

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1Royal Free and University College Medical School, London, United Kingdom

2002-11-17
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