513 Predictors of Plasma HIV RNA Control after Discontinuation of HAART Initiated at Acute Infection A. Lafeuillade*1, E. Counillon2, C. Poggi1, G. Hittinger1, D. Emilie3 1Gen Hosp, Toulon, France; 2Gen Hosp, Frejus, France; and 3INSERM, Clamart France
Background: Therapy initiated at acute HIV infection can be discontinued in some patients without major viral rebound.
Objective: To determine predictors of long-term control of viremia after discontinuation of HAART in patients (pts) treated during primary HIV infection.
Methods: Thirty (30) pts with acute infection (less than 3 bands on Western blot) received either a triple NRTI therapy (n = 15) or a combination of d4T, ddI, nelfinavir, saquinavir, hydroxyurea (500 mg bid) + 3 courses of IL-2 (n = 15) for 24 months (mos). HIV RNA in plasma, in PBMC and in lymph node (LN) cells; HIV DNA in PBMC; and circulating lymphocyte subsets, were regularly measured. Proliferative responses against p24 were tested at mo 24. At that time, 3 cycles of structured therapeutic interruptions (STI) were performed and HAART resumed for 3 mos when plasma viremia was consistently > 5,000 copies/ml. Statistical analysis used the NCSS package.
Results: All cases reached plasma viremia < 20 copies/ml after initiating therapy. After 1-3 STI cycles, 2/15 pts in the first therapy group compared with 12/15 in the second therapy group maintained viremia < 5,000 copies/ml without resuming therapy (median follow-up 19 mos), including 2 pts in the last group who remained consistently < 20 copies/ml. CD4, CD8, CD4CD45RO, CD4CD45RA, CD8CD38, CD3HLADR cell counts were not correlated with response either at baseline or M24. Baseline viremia and baseline proviral DNA levels, PBMC and LN HIV RNA levels at M24, were not correlated. Responders exhibited lower PBMC DNA levels at M24 than non-responders (median: 1.3 vs 1.9 log copies/million cells; p = 0.01) and higher proliferative responses against p24 (median 9- vs 2-fold).
Conclusions: In this series, the multivariate analysis identified a low proviral DNA level in PBMC at M24 and a strong proliferative response against p24 as independant predictors of viral control after cessation of therapy initiated at acute infection.
