For years now there has been controversy about whether early HIV infection should be treated. Could the immune system be spared the ravages of the HIV virus through early therapy? Or does early therapy just make treatment last longer? The jury has been out, and might still be deliberating, but a new piece of evidence has emerged.
Deeks et al have shown that, compared to people treated later in HIV disease, those treated within 6 months of initial infection show less immune system damage over time. This might be a sign that early treatment is good.
We still lack clear evidence that such benefits of early treatment outweigh the downsides of HIV treatment. The side effects, costs and other risks are real. So, we still await a clear sign.
When face-to-face with a patient with early HIV infection, I tell them what we know, and what we don't, and we share the decision-making. Does the possibility of ongoing immune damage scare them enough to make taking an HIV pill or two daily worth it? Or does the prospect of starting decades of therapy freak them out more? We talk through it, and most (but not all) start therapy.
Someday, let's hope we know more.