695 
Can HAART Initiation at Early Acute HIV Infection Benefit the Immune-virology Outcome Despite Subsequent Treatment Cessation? The ANRS Reservoirs’ Study Group
Thierry Prazuck*1, A Lafeuillade2, L Hocqueloux1, J P Viard3, V Avettand Fenoel4, and C Rouzioux4
1Ctr Hosp Regional Orleans La Source, France; 2Hosp Chalucet, Toulon, France; 3Ctr Hosp Univ Necker, Paris, France; and 4Ctr Hosp Univ Necker, Paris, France
Background: We wanted to evaluate the
immune-virology outcome of patients initiating HAART very early at acute HIV
infection and for several years before discontinuation, and to compare it with
non-treated patients after a documented HIV seroconversion diagnosed in the
same multicenter observational cohort setting.
Methods: Patients were enrolled within 10
weeks after the first acute symptoms and self-decided to initiate HAART or not.
Patients who received HAART (n = 20) were treated for a median period of
2.3 years (range 1 to 7 years), then stopped therapy, whereas untreated
patients (n = 18) were those who actually refused therapy. HIV RNA
levels and CD4 T cell counts were compared within the 2 groups every 12 week
and at weeks 48, 96, and 144 following treatment cessation.
Results: Age, sex, median CD4 T cell counts, and
median viral loads were similar in the 2 groups at the acute phase. Treated
patients maintained a viral load <400 copies/mL in 42.1%, 36%, and 31% of
cases at weeks 48, 96, and 144, respectively, after treatment cessation,
compared to 56%, 0%, and 0% at the same time points (p <0.001) for
untreated patients. A viral load <50 copies/mL was observed in 25% of
patients in the treated group after treatment interruption compared to none in the
untreated group at the week 144 time-point (p = 0.0001). After 3 years
of follow-up, 71% of patients in the treated group compared with 13% in the
untreated group were eligible for treatment initiation or re-introduction
according French guidelines (p = 0.014). The median monthly loss in CD4
T cells was twice higher in the untreated group than in the treated group
following treatment cessation (–11.1 vs –6.5 cells/mm3/month,
respectively). In the subgroup of treated patients who maintained viral load control
despite treatment cessation, we observed a slight increase in the CD4 T cells
slope all over the 3 years (+2 CD4/month). In the treated group, the ratio of
HAART duration over HAART delay from acute symptoms to therapy was
significantly higher for patients with viral load control than for others (0.91
vs 0.56 year per week; p = 0.04)
Conclusions: Early HAART initiation during primary
infection and continuation for several years was associated in this cohort
study with significant viral load and CD4 T cells benefits for at least 144
weeks following therapy cessation. These observational data add new evidence
for considering HAART initiation at primary HIV infection.
|
