The effect of antiretroviral treatment of different durations in primary HIV infection

Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece.
AIDS (London, England) (Impact Factor: 5.55). 12/2008; 22(18):2441-50. DOI: 10.1097/QAD.0b013e328319ea4e
Source: PubMed


To compare immunological, virological and clinical outcomes in persons initiating combination antiretroviral therapy (cART of different durations within 6 months of seroconversion (early treated) with those who deferred therapy (deferred group).
CD4 cell and HIV-RNA measurements for 'early treated' individuals following treatment cessation were compared with the corresponding ART-free period for the 'deferred' group using piecewise linear mixed models. Individuals identified during primary HIV infection were included if they seroconverted from 1st January 1996 and were at least 15 years of age at seroconversion. Those with at least 2 CD4 less than 350 cells/microl or AIDS within the first 6 months following seroconversion were excluded.
Of 348 'early treated' patients, 147 stopped cART following treatment for at least 6 (n = 38), more than 6-12 (n = 40) or more than 12 months (n = 69). CD4 cell loss was steeper for the first 6 months following cART cessation, but subsequent loss rate was similar to the 'deferred' group (n = 675, P = 0.26). Although those treated for more than 12 months appeared to maintain higher CD4 cell counts following cART cessation, those treated for 12 months or less had CD4 cell counts 6 months after cessation comparable to those in the 'deferred' group. There was no difference in HIV-RNA set points between the 'early' and 'deferred' groups (P = 0.57). AIDS rates were similar but death rates, mainly due to non-AIDS causes, were higher in the 'deferred' group (P = 0.05).
Transient cART, initiated within 6 months of seroconversion, seems to have no effect on viral load set point and limited beneficial effect on CD4 cell levels in individuals treated for more than 12 months. Its long-term effects remain inconclusive and need further investigation.

Download full-text


Available from: Philippe Vanhems, Oct 09, 2015
1 Follower
12 Reads
  • Source
    • "However, the rate of post-therapy control following ART administration during the acute phase may be lower (≈5%) according to another report [28]. Moreover, no definite timing and drug composition has been proven to reproducibly induce post-therapy control even in a minority of patients, and several studies have failed to induce any significant reduction in the post-therapy viral set point following treatment during acute infection [31-33]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Despite the huge clinical success of antiretroviral therapy, several factors such as side effects, requirement of life-long adherence, high cost, incomplete access to therapies and development of drug resistance make the quest for an ultimate cure of HIV/AIDS a worldwide priority of biomedical research. In this respect, several sterilizing or functional cures have been reported in the last years in both non-human primates and humans. This review provides a summary of the main results achieved so far, outlining their strengths as well as their limitations. A synthetic interpretation of these results could be pivotal in order to develop an effective and widely available cure.
    Retrovirology 11/2013; 10(1):145. DOI:10.1186/1742-4690-10-145 · 4.19 Impact Factor
  • Value in Health 11/2006; 9(6). DOI:10.1016/S1098-3015(10)63251-2 · 3.28 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: HIV infection starts as an acute, systemic infection, followed by a chronic period of clinical latency, usually lasting 3 to 10 years, which precedes the eventual collapse of the immune system. It is increasingly recognized that events occurring during acute HIV infection may determine the natural course of the disease. The very dynamic events of acute HIV infection provide multiple opportunities for biologic interventions, such as anti-retroviral or immune-based therapies. Similarly, the implementation of public health measures during acute HIV infection could help control epidemics or outbreaks. Many of the dramatic possibilities for intervention in acute HIV infection remain unproved, not the least because of traditional difficulty of diagnosing patients during this early period. This article reviews the natural history, pathogenesis and clinical presentation of acute HIV infection, and suggests a diagnostic and therapeutic approach to guide clinicians dealing with patients with suspected or confirmed acute HIV infection.
    Infectious Disease Clinics of North America 04/2007; 21(1):19-48, vii. DOI:10.1016/j.idc.2007.01.008 · 2.73 Impact Factor
Show more