Abstract
BackgroundWe explored the impact of transient cART started during the primary HIV-infection (PHI) on the long-term immunologic and virologic response on cART resumption, by comparison with treatment initiation during the chronic phase of HIV infection (CHI).MethodsWe analyzed data on 1450 patients enrolled during PHI in the ANRS PRIMO cohort between 1996 and 2013. “Treatment resumption” was defined as at least 3 months of resumed treatment following interruption of at least 1 month of treatment initiated during PHI. “Treatment initiation during CHI” was defined as cART initiated ≥6 months after PHI. The virologic response to resumed treatment and to treatment initiated during CHI was analyzed with survival models. The CD4 cell count dynamics was modeled with piecewise linear mixed models.Results136 patients who resumed cART for a median (IQR) of 32 (18–51) months were compared with 377 patients who started cART during CHI for a median of 45 (22–57) months. Most patients (97%) achieved HIV-RNA <50 cp/mL after similar times in the two groups. The CD4 cell count rose similarly in the two groups during the first 12 months. However, after 12 months, patients who started cART during CHI had a better immunological response than those who resumed cART (p = 0.01); therefore, at 36 months, the gains in √CD4 cells/mm3 and CD4% were significantly greater in patients who started treatment during CHI.ConclusionThese results suggest that interruption of cART started during PHI has a significant, albeit modest negative impact on CD4 cell recovery on cART resumption.
Highlights
We explored the impact of transient cART started during the primary HIV-infection (PHI) on the long-term immunologic and virologic response on cART resumption, by comparison with treatment initiation during the chronic phase of HIV infection (CHI)
WHO, European AIDS clinical society and BHIVA guidelines are still based on the CD4 cell count for treatment initiation in asymptomatic patients with primary HIV infection [3,4]
Baseline characteristics Among the 1450 patients enrolled in the ANRS PRIMO cohort, 377 started cART during CHI, while 136 patients started a second course of ART after transient treatment started during PHI
Summary
We explored the impact of transient cART started during the primary HIV-infection (PHI) on the long-term immunologic and virologic response on cART resumption, by comparison with treatment initiation during the chronic phase of HIV infection (CHI). In 2013, American and French guidelines recommended universal treatment of HIV infection regardless of the CD4 cell count. Treatment initiation for patients with primary infection changed from “should be considered optional” to “should be offered” [1,2]. WHO, European AIDS clinical society and BHIVA guidelines are still based on the CD4 cell count for treatment initiation in asymptomatic patients with primary HIV infection [3,4]. Treatment initiation during primary HIV infection (PHI) has both advantages and disadvantages: it limits the loss of CD4 cells, suppresses viremia, limits the size of the latent reservoir, attenuates immune activation [5,6,7], and reduces infectivity [8]. Earlier initiation of what, for remains a lifelong therapy may undermine patients’ quality of life
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