125LB
No Benefit from Early Treatment in Primary HIV-Infection?
Christine Koegl*1, E Wolf1, H Jessen2, K Schewe3, M Rausch4, J Goelz5, A Goetzenich6, H Knechten6, H Jaeger7, and the Prime-DAG and Ac-DAG Study Group
1MUC Res, Munich, Germany; 2Private Practice, Berlin, Germany; 3Practice St Georg, Hamburg, Germany; 4Priviate Practice, Berlin, Germany; 5HIV Outpatient Practice Kaiserdamm, Berlin, Germany; 6DAGNAE eV, Aachen, Germany; and 7HIV Res and Clin Care Ctr Munich, Germany
Background: The scientific
data on an optimal management of primary HIV-infection are inconclusive. There
is only poor evidence that early treatment of primary/acute HIV infection can
reduce the viral load set point or improve cellular immune functions.
Methods: We subjected 2
national cohorts to prospective analysis:
Prime-DAG started in July 2001 with a focus on early treatment, and
Ac-DAG started in January 2003 with a focus on non-treatment of primary
HIV-infection. Criteria for primary HIV infection were either a negative ELISA
coupled with a positive viral load, or a documented Western blot with <5
bands. CD4 cell counts and viral load in untreated patients 12 months after
seroconversion were compared with treated patients 12 months after treatment stop.
Results: We
included 200 cases (191 male) of primary HIV-infection. In 144 patients,
treatment was started immediately, while 56 patients remained untreated. In
patients without treatment, the median first measured viral load was 240,000
copies/mL vs 500,001 copies/mL in patients initiating treatment (p <0.001). The median CD4 counts were
629/µL and 453/µL, respectively (p =
0.001). Of 144 treated patients, 100 stopped treatment after a median time of
9.5 months. At this time point, viral load was below detection in 82% of these
patients (range, <49 to 7220 copies/mL). The median CD4 count was 799/µL; 12
months after treatment stop (n = 44),
the median viral load was 38,056 copies/mL (range, <49 to 492,000
copies/mL). In 2 patients, viral load was still below detection. The median CD4
count was 538/µL (range, 183 to 1138 µL). There was a median CD4 increase of
+60/µL in comparison to the first CD4 cell count (baseline). In untreated
patients (n = 37), the median viral
load was 52,880 copies/mL (range, 150 to 1,600,000 copies/mL) and the median
antibodies. CD4 count was 525/µL (range, 90 to 1057/µL) 12 months after
seroconversion. Untreated patients had a median CD4 decrease of –87/µL in
comparison to the first CD4 cell count (baseline, p = 0.01).
Conclusions: In
this relatively large cohort of acute, primary infected HIV patients, early
treatment did not change the viral load set point. However, there was an
advantage with regard to immune function:
12 months after seroconversion a median CD4 decrease of –87/µL was
observed in untreated patients. In treated patients, 12 months after stopping
treatment, CD4 cell count was still increased by +60 µL compared with
seroconversion.
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