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July 1, 1998

The Case for Conservative Management of Early HIV Disease

Author Affiliations

From the Infectious Diseases/AIDS Clinic, Denver Public Health and the Department of Medicine, Division of Infectious Disease, University of Colorado Health Sciences Center, Denver.


Controversies section editor: Phil B. Fontanarosa, MD, Senior Editor.

JAMA. 1998;280(1):93-95. doi:10.1001/jama.280.1.93

THE LAST 3 years have been a remarkable time to be involved in the care of patients with human immunodeficiency virus (HIV) infection. Improvements in antiretroviral therapy have decreased the rates of death and opportunistic infections by about 70% in our clinic (W.J.B., R.R.R., and D.L.C., unpublished data, 1998) and brought an atmosphere of hope to patients and clinicians. However, we read with concern the 1997 recommendations from the International AIDS Society–USA Panel regarding the use of therapy for all patients with an HIV RNA level greater than 5000 to 10000 copies/mL, regardless of CD4 cell count.1 Aggressive treatment of early HIV infection was also recommended by a panel convened by the Department of Health and Human Services.2 The Department of Health and Human Services panel was more conservative and presented the potential advantages and disadvantages of aggressive, early therapy, but eventually recommended treatment of any patient with a CD4 cell count less than 0.50×109/L (<500/µL) or a viral load greater than 10000 to 20000 copies/mL.