• The Effect of Pre-Treatment on Success of HAART Among Patients with Primary HIV (Poster 401)
  Authored by R. Geise, J. Maenza, A. Collier, S. Holte, C. Stevens, D. Hughes, and L. Corey
  View the original abstract

Is it better to delay therapy for newly-infected individuals who may not be ready for HAART in the acute situation than to administer a less-potent but more tolerable regimen? This retrospective, non-randomized study attempts to shed some light on the cost of early but less-potent therapy in acute HIV infection.

Twenty-nine individuals identified with acute HIV infection between 1993-97 were compared with respect to baseline immunologic and virologic status and the same parameters after two years of HAART. Fifteen patients received monotherapy (six patients) or dual therapy (nine patients) with nucleoside analogs after diagnosis for a median of 387 days (range 90-845) prior to initiation of HAART; 14 patients deferred therapy. At the initiation of HAART the two groups had similar CD4 cell counts but the naive group had a significantly higher viral load, 47,661 copies compared to 2,309 copies in the treated group (p=0.0001). The period of delay was a median of 434 days for the naive patients.

After two years of HAART, there were no significant differences in CD4 cell counts or viral load between the groups, and all 29 were suppressed to median viral load of 45 copies.

These limited data suggest that administering nucleoside analogs alone early in acute infection did not compromise longer-term outcomes. A companion poster by the same group (abstract 400) demonstrates a 19-fold enhanced risk of virologic failure among acutely-infected individuals when therapy was delayed for more than one year. Bruce Walker has previously shown that immunologic preservation is optimized by treatment in acute HIV infection. These data suggest that virologic outcome may be impacted more by delay of treatment than by early treatment with less optimal regimens.