Rapid CD4+ cell decrease after transient cART initiated during primary HIV infection (ANRS PRIMO and SEROCO cohorts)
Objective: To modelize the rate of CD4+ cell count decline and its determinants after cessation of combination antiretroviral therapy (cART) started during primary HIV infection (PHI) and compare it with never-treated patients. Methods: Kinetics of CD4+ counts were analyzed on the square root scale by using a mixed-effects model in 170 patients who received cART during PHI from the Primary Infection (PRIMO) cohort and 123 never-treated patients from the Seroconverters (SEROCO) cohort. Results: After cART interruption in the PRIMO cohort, the CD4+ cell count fell rapidly during the first 5 months and more slowly thereafter. The timing of treatment initiation had no influence on the rate of CD4+ cell decline. In contrast, a larger increase in CD4+ cell counts during cART was associated with a steeper decline and a larger loss of CD4+ cells after treatment interruption. The mean CD4+ cell loss 3 years postinterruption was 383 cells per microliter. In the SEROCO cohort, the CD4+ T-cell decline was less steep (3-year CD4+ loss 239 cells/μL). As a result, the mean CD4+ cell counts were similar (416 cells/μL) 3 years after cART interruption (PRIMO) or after infection (SEROCO). Conclusions: These data question the benefit of a limited course of cART even when initiated within 3 months after PHI diagnosis.