Journal Article

Longitudinal Analysis of Clinical Markers following Antiretroviral Therapy Initiated during Acute or Early HIV Type 1 Infection

Sigall Kassutto, Kaveh Maghsoudi, Mary N. Johnston, Gregory K. Robbins, Nicole C. Burgett, Paul E. Sax, Daniel Cohen, Eunice Pae, Ben Davis, Kimon Zachary, Nesli Basgoz, Erika M. C. D'agata, Victor DeGruttola, Bruce D. Walker and Eric S. Rosenberg

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 42, issue 7, pages 1024-1031
Published in print April 2006 | ISSN: 1058-4838
Published online April 2006 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/500410
Longitudinal Analysis of Clinical Markers following Antiretroviral Therapy Initiated during Acute or Early HIV Type 1 Infection

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Background. Treatment of acute human immunodeficiency virus type 1 (HIV-1) infection may have unique immunologic, virological, and clinical benefits. However, the timing of treatment, optimal starting regimens, and expected response to therapy have not been defined.

Methods. One hundred two subjects treated during acute and early HIV-1 infection were observed prospectively to determine the effect of time elapsed before initiation of therapy on time to virological suppression and absolute CD4+ cell count. Subjects were divided into pre- and postseroconversion groups on the basis of HIV-1 antibody status at the time of initiation of treatment. Absolute CD4+ cell counts were compared between these groups and with those of historical untreated persons who had experienced seroconversion. Potential predictors of time to virological suppression and CD4+ cell count at ⩾12 months were assessed.

Results. Ninety-nine (97%) of 102 subjects achieved virological suppression. The median time to suppression was 11.1 weeks (95% confidence interval, 9.4–14.9) and was independent of initial regimen. The mean CD4+ cell count at 12 months was 702 cells/mm3 (95% confidence interval, 654–750 cells/mm3) and showed an increasing trend over 60 months. Treated subjects demonstrated a statistically significant gain in the CD4+ cell count, compared with untreated historical control subjects, at ⩾12 months. Comparable virological and immunologic outcomes were seen in the pre- and postseroconversion groups. Baseline virus load and nadir CD4+ cell count predicted time to virological suppression and CD4+ cell count at ⩾12 months, respectively.

Conclusions. Early treatment of HIV-1 infection is well tolerated and results in rapid and sustained virological suppression. Preservation of CD4+ cell counts may be achieved with early therapy, independent of seroconversion status. Protease inhibitor—based and nonnucleoside reverse-transcriptase inhibitor—based regimens show comparable performance in tolerability, time to virological suppression, and CD4+ cell count when used as a first regimen.

Journal Article.  4091 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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