Question
Will fewer cells be infected if I start treatment early?
14 August 2007. Related: All topics, CD4 and viral load.
I believe that I discovered my HIV infection two months after exposure as indicated by swollen lymph nodes in my head and neck.
I did labs about 2 weeks after the positive HIV test and the results were: CD4 266 and viral load over 100,000.
My doctor recommended that I go on medication (Truvada/Sustiva). So 3 months after I believe I was exposed, I started meds.
My questions is: how does this affect my long-term prognosis?
Did HIV infect fewer cells and maybe I have fewer HIV-infected cells in my body as compared to someone who has had HIV for years?
Additionally, I continue to have swollen lymph nodes in my neck 18 months after infection (but the ones in my head are gone). To stop my complaining, the doc ordered a CT scan and the results showed swollen lymph nodes but the results were ‘clear’.
My question is should I consider having these lymph nodes removed to further reduce the amount of HIV in body since HIV tends to live in lymphatic tissue? Thank you.
Answer
Hi
The swollen lymph nodes when you were first diagnosed were probably symptoms of seroconversion (when you body’s immune system generates a response to HIV).
Although your CD4 count may have increased after this, and your viral load may have come down lower again by itself, having symptoms at any stage is a reason to use HIV treatment.
Earlier treatment is likely to have infected fewer cells, and also stopped the virus from mutating very much. It isn’t clear whether either of these thing in themselves with have a clinical benefit (ie that they will help you live longer), but they are not a bad thing.
There are other potential benefits of starting treatment earlier that are the subject of research.
It is good that a check of your lymph nodes show that they are clear. Although most HIV in your body is in the lymph system (only 2% of HIV is in blood), this isn’t a reason to start taking out your lymph nodes. Your body has hundreds of lymph nodes and needs the lymph system to drain impurities and waste products from the blood.
When you start treatment, your viral load should become undetectable in the blood first. Then after several months of being undetectable in the blood, the virus will reach undetectable levels in the lymph system.
After this, any new virus comes from when resting or sleeping HIV-infected cells wake and start making more HIV.
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