Early Antiretroviral Therapy During Primary HIV-1 Infection Results in a Transient Reduction of the Viral Setpoint upon Treatment Interruption

Publication

Early Antiretroviral Therapy During Primary HIV-1 Infection Results in a Transient Reduction of the Viral Setpoint upon Treatment Interruption

Journal Paper/Review - Nov 15, 2011

von Wyl Viktor, Günthard Huldrych F, Joos Beda, Weber Rainer, Vernazza Pietro, Hirschel Bernard, Rauch Andri, Cavassini Matthias, Bernasconi Enos, Battegay Manuel, Kuster Herbert, Niederoest Barbara, Fischer Marek, Gianella Sara, the Swiss HIV Cohort Study (SHCS)

Citation

von Wyl V, Günthard H, Joos B, Weber R, Vernazza P, Hirschel B, Rauch A, Cavassini M, Bernasconi E, Battegay M, Kuster H, Niederoest B, Fischer M, Gianella S, the Swiss HIV Cohort Study (SHCS). Early Antiretroviral Therapy During Primary HIV-1 Infection Results in a Transient Reduction of the Viral Setpoint upon Treatment Interruption. PloS one 2011; 6:e27463.

Type

Journal Paper/Review (English)

Journal

PloS one 2011; 6

Publication Date

Nov 15, 2011

Issn Electronic

1932-6203

Pages

e27463

Brief description/objective

BACKGROUND: Long-term benefits of combination antiretroviral therapy (cART) initiation during primary HIV-1 infection are debated. METHODS: The evolution of plasma HIV-RNA (432 measurements) and cell-associated HIV-DNA (325 measurements) after cessation of cART (median exposure 18 months) was described for 33 participants from the Zurich Primary HIV Infection Study using linear regression and compared with 545 measurements from 79 untreated controls with clinically diagnosed primary HIV infection, respectively a known date for seroconversion. RESULTS: On average, early treated individuals were followed for 37 months (median) after cART cessation; controls had 34 months of pre-cART follow-up. HIV-RNA levels one year after cART interruption were -0.8 log(10) copies/mL [95% confidence interval -1.2;-0.4] lower in early treated patients compared with controls, but this difference was no longer statistically significant by year three of follow-up (-0.3 [-0.9; 0.3]). Mean HIV-DNA levels rebounded from 2 log(10) copies [1.8; 2.3] on cART to a stable plateau of 2.7 log(10) copies [2.5; 3.0] attained 1 year after therapy stop, which was not significantly different from cross-sectional measurements of 9 untreated members of the control group (2.8 log(10) copies [2.5; 3.1]). CONCLUSIONS: The rebound dynamics of viral markers after therapy cessation suggest that early cART may indeed limit reservoir size of latently infected cells, but that much of the initial benefits are only transient. Owing to the non-randomized study design the observed treatment effects must be interpreted with caution.