Background. Highly active antiretroviral therapy (HAART) during acute retroviral syndrome (ARS) provides effective suppression of HIV replication and may limits escape mutations. The time to initiate HAART during ARS is not clearly established. We explored the early effect of HAART on plasma HIV viral load (VL) and CD4 lymphocytes when HAART was started before or after the end of ARS.

Methods. Prospective observational cohort of 99 patients (pts) with documented ARS from Lyon, France, and Montreal, Canada. HAART was started before the end of ARS for 20 pts, after the end of ARS for 40 pts, between 6 months (mos) and 12 mos for 30 pts and 9 were not treated within 12 mos. The adjusted relative risk (aRR) to achieve a VL< 500 copies/mL and CD4 > 500 cells/mm³ within 6 mos after onset according to ARS duration and timing of HAART initiation was calculated using a Cox model. The Kaplan-Meier method was used to calculate the median time to achieve each outcome and comparisons were based on the Log-rank test. The log₁₀ VL and CD4 were compared at 6 mos setpoint and at 12 mos by ANOVA.

Results. Median duration of ARS was 23 days (d). The table shows the Cox model adjusted for age (p = 0.2) and gender (p = 0.5), the median time from onset ARS to reach VL < 500 and CD4 > 500 and comparisons of log₁₀ VL and CD4 mean values at 6 mos setpoint and 12 mos.

 

 * Reference group, ** p<.01, *** p=.12

 

Conclusions. The rate of VL decrease and CD4 increase within 12 mos of infection is associated with the time of starting HAART during ARS. Subtle differences in delay of HAART at ARS might explain various VL and CD4 patterns observed early after ARS.