Early Antiretroviral Therapy at Primary HIV Infection
A new study is published showing that early ART initiation within 60 days of the estimated date of infection (EDI) produces lower plasma HIV RNA and cell-associated HIV DNA setpoints, after one year, relative to patients with later ART initiation or untreated control.
The paper is intitled: "Effect of early antiretroviral therapy during primary HIV-1 infection on cell-associated HIV-1 DNA and plasma HIV-1 RNA" by Gianella S, von Wyl V, Fischer M. et al Antiviral Therapy 2011; 16: 535-545 (doi: 10.3851/IMP1776).
The authors compared ART initiated within 60 days after the EDI in 24 patients to late starters (8 patients who started between 61 and 121 days after EDI) and to 89 controls who were patients from the Swiss HIV Cohort Study with known dates of seroconversion but no treatment initiated.
ART initiated at acute infection comprised 2 NRTIs + Kaletra* in all but one case (on Nelfinavir).
The main findings of this study are that:
-3 patients in the group (9%) starting ART within 60 days from the EDI maintained undetectable plasma HIV RNA after cessation of ART: follow up ranges from 0.8 to 2.5 years
-post cessation mean cell-associated HIV DNA setpoints were 2.3 log in early starters compared to 2.7 log copies/million cells in late starters.
-in early starters compared to untreated controls, there was a 1.2 log difference in viremia setpoint (and a 1 log difference with late starters).
These are positive signs. However, sample size is small and follow up is short.
Key words: acute HIV infection, cell-associated HIV DNA