401   The Effect of Pre- Treatment on Success of HAART Among Patients with Primary HIV.

R. Geise*¹, J. Maenza¹, A. Collier¹, S. Holte², C. Stevens¹, D. Hughes¹, and L. Corey¹.
¹Univ. of Washington and²Fred Hutchinson Cancer Res. Ctr., Seattle.

Background:Whether prior mono/dual therapy early after the development of HIV influences long-term outcome with HAART is currently unknown. The objective of this study was to assess the impact of mono- or dual therapy prior to the initiation of HAART in patients not treated with HAART during acute HIV infection.

Methods:Between 1993 and 1997, we followed 15 subjects who received therapy with either one or two nucleoside analogs early after acquisition of HIV. These subjects were placed on HAART (defined as 3 anti- retroviral (ARV) drugs from at least two different drug classes) when available. They were compared with 14 others who were ARV naïve prior to initiation of HAART and delayed therapy until after their primary infection (defined as within 120 days of presumed seroconversion). After 2 years of HAART for both groups, a comparison was made between immunologic and virologic parameters.

Results:Both groups were similar at presentation. The group receiving prior therapy was treated with a mixture of mono- and/or dual therapy for a median of 387 days (range 90—845 days) prior to initiating HAART and delayed HAART a median of 1015 days after seroconversion. The naïve group started HAART a median of 434 days after seroconversion (p = 0.02). At initiation of HAART, the group receiving prior therapy had a median CD4 count of 409 cells/ml compared to the naive group with a median CD4 count of 386 cells/ml (p = 0.98). Median viral load at initiation of therapy was 2,309 copies/ml in the prior therapy group compared to 47,661 copies/ml in the naive group (p = 0.0001). After two years of therapy, the prior therapy group had a median CD4 count of 687cells/ml and median viral load of 45 copies/ml compared to the naive group with a median CD4 count of 642 cells/ml and a median viral load of 45 copies/ml (p = 0.83 and 0.50, respectively).

Conclusions:Prior therapy with less than highly active anti-retroviral therapy has no impact on immunologic and virologic parameters after two years of HAART in a group followed since acute infection when compared with a similar group that was ARV naïve at the initiation of HAART. As presented elsewhere, therapy delay has a greater impact on these parameters than pre-treatment.