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Should patients with the "flu-like" or "mono-like" illness of primary HIV infection be treated?
Patients who are identified with HIV around the time they are first infected (primary, acute infection) may benefit from potent antiviral therapy given at that time. The rationale for initiating this early treatment is primarily theoretical. Preliminary evidence, however, suggests that unique aspects of the body's immune response to the virus may be preserved by this strategy. It is thought that treatment during the primary infection may be an opportunity to help the body's natural defense system to work against HIV. Thus, patients may gain an improved control of their infection while on therapy, and perhaps even after therapy is stopped. At one time, the hope was that if therapy was started very early in the course of the infection, HIV could be eradicated. Most evidence today however suggests that this is not the case. Consequently, early treatment is not likely to result in a cure, although other benefits may still exist. Therefore, the current recommendation is that patients with primary infection should be referred to clinical studies where the potential role of therapy can be discussed and further explored. If emotional or social situations make adherence to such treatment questionable, however, the patients are clearly better off delaying therapy. After all, on the average, infected persons can expect to remain healthy for a prolonged period of time. Regardless, patients need to be aware that initiating treatment early puts them at risk for developing short and long-term side effects as well as resistance to the drugs.