| Popis: |
Increasingly, evidence is accumulating that combination antiretroviral therapy can markedly prolong the time to development of AIDS-defming opportunistic infections and death. 12 As such, a natural extension of this concept is the use of antiviral therapy very early in the course of infection, especially at the time of HIV-1 seroconversion. Several recent articles have shown that the initial days and weeks after exposure and establishment of HIV are critical in defining host/virus interactions and subsequent disease course. Within 4 months after infection a viral inflection point is reached; after this point the level of mRNA in plasma is predictive of clinical progression and time to death.35 In addition, host immune responses, especially cytotoxic T-lymphocyte (CTL) responses, correlate with plasma virus levels, and therefore with subsequent progression of disease.6 Diversity of host cell response is also predictive: individuals with a less restricted immune response to HIV appear to have a lower rate of disease progression.7 These data suggest that early intervention affords the best opportunity to maximize the care of the HIV-infected patient. |
