23
Effect of Treatment during versus after Acute Retroviral Syndrome (ARS) on HIV Viral Load and CD4 Cell Counts within 3 Years of Infection
N Voirin*1, D Smith2, J P Routy3, M Legault3, D Baratin4, C Trepo1,5, L Cotte5, J M Livrozet4, J L Touraine4, D A Cooper2, A Gayet-Ageron4, J Ritter4, J Fabry4, and P Vanhems1,4
1INSERM U271, Lyon, France; 2Univ. of New South Wales, Sydney, Australia; 3McGill Univ., Montreal, Canada; 4Edouard Herriot Hosp., Lyon, France; and 5Hotel Dieu Hosp., Lyon, France
Background: Starting antiretroviral therapy (ART) during ARS might influence immediate
immunological response and control of virological replication but it is unknown
if this benefit persists over time. We therefore compared the HIV viral load
and the CD4 cell counts at different time points from the initiation of ART among patients treated during or treated after
ARS.
Methods: Data
from patients enrolled from 1995 to 2003 in 3 prospective primary HIV infection
cohorts with similar follow-up (Lyon, Montreal,
and Sydney)
were analyzed. We compared mean HIV viral load and CD4 counts at initiation of
therapy, 6 months and 1, 2, and 3 years after start of therapy between patients
with documented ARS treated during or after ARS, using Kruskal-Wallis rank sum
test.
Results: Of a
total of 203 patients, 188 (93%) were male, mean age 34.5 years. The presumed
route of HIV infection was men who had sex with men for 148 (73%), heterosexual
contact for 21 (10%), and injecting drug use for 33 (16%). ART was started after ARS for 117 (58%) (Gr1),
during ARS for 51 (25%) (Gr2), and 35 (17%) received no therapy during the
follow-up (Gr0). The mean time between onset of ARS and start of therapy was
164 days for Gr1 and 27 days (p =
0.001) for Gr2. No difference was observed between the 3 groups for gender (p = 0.65) and age (p = 0.47). The table shows the HIV viral load and CD4 count for
each group at the various time points. Similar results persist after adjustment
on ARS severity score.
|
Time from start of therapy
|
Mean log10 HIV RNA
|
|
Mean CD4 count/mm3
|
|
Gr0
|
Gr1
|
Gr2
|
p1*
|
p2**
|
|
Gr0
|
Gr1
|
Gr2
|
p1
|
p2
|
|
Baseline
|
4.63
|
4.27
|
4.58
|
0.11
|
0.06
|
|
697
|
540
|
621
|
0.10
|
0.05
|
|
6 months
|
3.91
|
1.97
|
1.78
|
<0.01
|
0.40
|
|
538
|
662
|
722
|
0.01
|
0.30
|
|
1 year
|
4.24
|
2.13
|
1.73
|
<0.01
|
0.26
|
|
567
|
657
|
721
|
0.11
|
0.14
|
|
2 years
|
3.84
|
2.34
|
2.28
|
0.03
|
0.57
|
|
468
|
764
|
694
|
0.04
|
0.76
|
|
3 years
|
4.77
|
1.01
|
1.70
|
0.10
|
0.09
|
|
380
|
938
|
693
|
0.27
|
0.82
|
Keywords: Acute infection; HAART; early initiation
