December 27, 2013
During the earliest weeks of HIV infection, known as primary HIV infection (PHI), the virus replicates rapidly before the immune system begins producing antibodies against it. Recent evidence -- from a Mississippi child and members of the French VISCONTI Cohort -- suggests that starting HIV treatment during this very early stage may have significant benefits even after treatment is interrupted.
Researchers with the First Hospital of China Medical University recently conducted a meta-analysis to assess how short-course antiretroviral treatment during primary infection affects future immune function and viral suppression. Their findings appear in the December 6, 2013, edition of PLoS ONE.
Ultimately only a limited number of studies met the researchers' criteria for inclusion, but their analysis revealed that a short course of treatment in early HIV infection was linked with both increased CD4 cell counts and reduced viral load within one year after treatment was interrupted. "The conclusions from our study would help the decision-making in the clinical management of PHI," the authors note.
Although treatment interruption is not currently recommended, these results point the way for further study of novel approaches to treating HIV early and managing the disease. (They also emphasize the need for earlier diagnosis of HIV infection.) Access to the full article is free at PLoSONE.org. For an in-depth discussion of the meta-analysis, see Michael Carter's summary, excerpted below and available in full at AIDSmap.com.
By Michael Carter
December 27, 2013
A short course of antiretroviral therapy during primary HIV infection (PHI) has immunological and virological benefits after treatment is stopped, a meta-analysis published in the online journal PLoS One shows. The benefits of treatment were greatest for people with lower baseline CD4 cell counts and higher baseline viral loads, but did not last in the long term.
"Short-course treatment during PHI was associated with better immunological and virological outcomes after treatment interruption," write the authors. "This change is a clinically significant change, which may have a profound effect on HIV disease progression."
Early responses to HIV infection are associated with subsequent disease progression. For instance, a recent study showed that severity of PHI is associated with longer-term outcomes. However, the benefits of short-course antiretroviral therapy during PHI are unclear. A team of investigators from China therefore performed a meta-analysis of studies examining this question that were published before September 2013.
... A total of eight studies met the investigators' inclusion criteria. These were published between 2004 and 2012 and had sample sizes ranging from 11 to 822 patients. The duration of short-course therapy was between 12 and 86 weeks, and participants were followed for between nine months and six years after treatment was stopped.
Pooled results showed that short-course therapy during PHI had significant immunological and virological benefits. Twelve months after stopping, early treatment increased CD4 count by 86 cells/mm3 and reduced viral load by 0.30 log10 copies/ml, compared to untreated controls.
"Theoretically, the prevention of severe loss of CD4 T cells in peripheral blood and lymphoid tissues occurring during PHI, the preservation of HIV-specific cellular and humoral immune responses, the restriction of viral diversification, and the reduced size of the HIV reservoirs exerted by treatment during PHI may be the reasons explaining these benefits," the investigators suggest. ...