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. 2009 Jul 22;14(7):277-83.
doi: 10.1186/2047-783x-14-7-277.

Treatment during primary HIV infection does not lower viral set point but improves CD4 lymphocytes in an observational cohort

C Koegl  1 , E Wolf, N Hanhoff, H Jessen, K Schewe, M Rausch, J Goelz, A Goetzenich, H Knechten, H Jaeger, W Becker, I Becker-Boost, D Berzow, B Beiniek, J Brust, D Shcuster, S Dupke, S Fenske, H J Gellermann, R Gippert, P Hartmann, B Hintsche, H Jaeger, E Jaegel-Guedes, H Jessen, J Gölz, J Koelzsch, E B Helm, G Knecht, H Knechten, I Lochet, P Gute, S Mauruschat, S Mauss, V Miasnikov, F A Mosthaf, M Rausch, M Freiwald, B Reuter, H M Schalk, B Schappert, E Schnaitmann, I Schneider, W Schüler-Maué, C Schuler, T Seidel, W Starke, A Ulmer, M Müller, I Weitner, K Schewe, C Zamani, A Hanmond, K Ross, A Bottlaender, C Hoffmann, A Dix, A Schneidewind, M Lademann; Ac-DAG Study Group
Affiliations

Treatment during primary HIV infection does not lower viral set point but improves CD4 lymphocytes in an observational cohort

C Koegl et al. Eur J Med Res. .

Abstract

Objective: To investigate if early treatment of primary HIV-1 infection (PHI) reduces viral set point and/or increases CD4 lymphocytes.

Methods: Analysis of two prospective multi-centre PHI cohorts. HIV-1 RNA and CD4 lymphocytes in patients with transient treatment were compared to those in untreated patients. Time to CD4 lymphocyte decrease below 350/ microl after treatment stop or seroconversion was calculated using Kaplan-Meier and Cox-PH-regression analyses.

Results: 156 cases of PHI were included, of which 100 had received transient HAART (median treatment time 9.5 months) and 56 remained untreated. Median viral load (563000 cop/ml vs 240000 cop/ml; p<0.001) and median CD4 lymphocyte (449/ microl vs. 613/ microl; p<0.01) differed significantly between treated and untreated patients. Median viral load was 38056 copies/ml in treated patients (12 months after treatment stop) and 52880 copies/ml in untreated patients (12 months after seroconversion; ns). Median CD4 lymphocyte change was +60/ microl vs. -86/ microl (p = 0.01). Median time until CD4 lymphocytes decreased to <350/ microl (including all patients with CD4 lymphocytes <500/ microl during seroconversion) was 20.7 months in treated patients after treatment stop and 8.3 months in untreated patents after seroconversion (p<0.01). Cox-PH analyses adjusting for baseline VL, CD4 lymphocytes, stage of early infection and symptoms confirmed these differences.

Conclusions: Treatment during PHI did not lower viral set point. However, patients treated during seroconversion had an increase in CD4 lymphocytes, whereas untreated patients experienced a decrease in CD4 lymphocytes. Time until reaching CD4 lymphocytes <350/ microl was significantly shorter in untreated than in treated patients including patients with CD4 lymphocytes <500/ microl during seroconversion.

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Figures

Figure 1
Figure 1
Comparison of the progression of viral load in treated patients after treatment stop with untreated patients. Box-plot presentation including median values, 25th and 75th percentiles.
Figure 2
Figure 2
Changes in absolute CD4 lymphocytes in treated patients after treatment stop and untreated patients.
Figure 3
Figure 3
Kaplan-Meier analysis: Time to CD4 lymphocyte decrease below 350/μl in treated patients after treatment stop and untreated patients after seroconversion; including all patients with a CD4 lymphocyte < 500/μl during seroconversion.
See this image and copyright information in PMC

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