Background:  The relative immunological, virological, and clinical outcome of initiating HAART of different durations within 6 months of HIV seroconversion is not known. We compare such outcomes within an early treatment group and with those who deferred ART.

Method:  Comparison of CD4 counts and HIV RNA measurements for the early treated individuals were restricted to the period following treatment cessation, and before any ART was re-initiated, and the corresponding ART-free period for the deferred group. CD4 data were analysed using piecewise linear mixed models. Individuals were included if they seroconverted at or after January 1996, were ≥15 years at seroconversion, and identified during primary HIV infection. Those with ≥2 CD4 <350 cells/μL or AIDS within the first 6 months following seroconversion were excluded.

Results:  Of the 348 early treated individuals, 147 received ART of limited duration:  <6 months (38), 6 to 12 months (40), and >12 months (69). CD4 loss was steeper for the first 6 months following ART cessation but the subsequent rate of loss was similar to the corresponding rate for the 675 individuals in the deferred group (p = 0.26). Although those treated >12 months appeared to experience higher CD4 levels following ART cessation, those treated <12 months had comparable CD4 levels 6 months after cessation to those in the deferred group. There was no difference in HIV RNA set-points between the early and deferred groups (p = 0.43). AIDS rates were similar but death rates were higher in the deferred group (p = 0.05), mainly due to an increased number of non-AIDS deaths in this group.

Conclusions:  Transient ART, initiated within 6 months of HIV seroconversion, seems to have limited beneficial effects on CD4 cell count levels and no effect on viral load set-point. However its long-term effects are still inconclusive and need further investigation.