Abstract
The optimal time to start antiretroviral therapy for HIV-infected patients remains unknown [1-4]. Leaving public health considerations regarding transmission aside, if we are indeed able to diagnose HIV infection in patients at a very early stage, should we intervene with antiviral agents and, if so, for how long [5-7]? What is the potentially achievable long-term impact of highly active antiretroviral therapy (HAART) initiated around the time of HIV seroconversion, if such treatment is subsequently discontinued: lowering of the viral set point, preservation of CD4' T cells, a decrease in rates of disease progression, long-term control of HIV viremia, or even viral eradication [8-10]? In contrast, one may argue that very early initiation of HAART may still be provided too late to have a major impact, because virus-induced immunopathogenesis has already taken hold [11-13]. This realization would justify a more conservative treatment approach and the initiation of HAART only during chronic infection, because this approach still allows for substantial immune reconstitution in terms
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