Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Apr 10:15:178.
doi: 10.1186/s12879-015-0892-1.

Does transient cART started during primary HIV infection undermine the long-term immunologic and virologic response on cART resumption?

Evguenia Krastinova  1   2 , Remonie Seng  3   4 , Jerome Lechenadec  5 , Henri Panjo  6 , Asma Essat  7 , Djamila Makhloufi  8 , Martine Obadia  9 , Louis Bernard  10 , Cecile Goujard  11   12 , Laurence Meyer  13   14 ; ANRS PRIMO cohort
Collaborators, Affiliations

Does transient cART started during primary HIV infection undermine the long-term immunologic and virologic response on cART resumption?

Evguenia Krastinova et al. BMC Infect Dis. .

Abstract

Background: We explored the impact of transient cART started during the primary HIV-infection (PHI) on the long-term immunologic and virologic response on cART resumption, by comparison with treatment initiation during the chronic phase of HIV infection (CHI).

Methods: We analyzed data on 1450 patients enrolled during PHI in the ANRS PRIMO cohort between 1996 and 2013. "Treatment resumption" was defined as at least 3 months of resumed treatment following interruption of at least 1 month of treatment initiated during PHI. "Treatment initiation during CHI" was defined as cART initiated ≥6 months after PHI. The virologic response to resumed treatment and to treatment initiated during CHI was analyzed with survival models. The CD4 cell count dynamics was modeled with piecewise linear mixed models.

Results: 136 patients who resumed cART for a median (IQR) of 32 (18-51) months were compared with 377 patients who started cART during CHI for a median of 45 (22-57) months. Most patients (97%) achieved HIV-RNA <50 cp/mL after similar times in the two groups. The CD4 cell count rose similarly in the two groups during the first 12 months. However, after 12 months, patients who started cART during CHI had a better immunological response than those who resumed cART (p = 0.01); therefore, at 36 months, the gains in √CD4 cells/mm(3) and CD4% were significantly greater in patients who started treatment during CHI.

Conclusion: These results suggest that interruption of cART started during PHI has a significant, albeit modest negative impact on CD4 cell recovery on cART resumption.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Kaplan-Meier functions of time to HIV RNA < 50 copies/mL according to the timing of cART (resumption after transient treatment during PHI versus initiation during CHI), log rank test, p = 0.5.
Figure 2
Figure 2
Estimated CD4 count evolution on cART (in square root scale) from the piecewise linear mixed-effects model according to the mode of cART initiation. a/ cART resumption after transient treatment started during PHI versus cART initiated during CHI and the observed CD4 count values; b/ Estimated CD4 count evolution on cART (in square root scale) from the piecewise linear mixed-effects model according to mode of cART initiation: cART resumption after transient treatment started during PHI versus cART initiated during CHI; c/ Estimated CD4 count percentage evolution on cART from the piecewise linear mixed-effects model according to the mode of cART initiation: cART resumption after transient treatment started during PHI versus cART initiated during CHI; d/ Estimated CD4 cell count evolution in patients who started cART during PHI with unfavourable ((cutoffs CD4 < 500 cells/mm3 and HIV load ≥ 5 log) versus favorable baseline characteristics (cutoffs CD4 ≥ 500 cells/mm3 and HIV load < 5 log) versus patients who started cART during CHI.
See this image and copyright information in PMC

References

    1. DHHS: Department of Health and Human Services Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. In Book Department of Health and Human Services Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. 2013.
    1. Hoen B, Bonnet F, Delaugerre C, Delobel P, Goujard C, L'Henaff M, et al. French 2013 guidelines for antiretroviral therapy of HIV-1 infection in adults. J Int AIDS Soc. 2014;17:19034. doi: 10.7448/IAS.17.1.19034. - DOI - PMC - PubMed
    1. EACS . Book European AIDS Clinical Society guidelines. Europe: European AIDS Clinical Society EACS; 2013. European AIDS Clinical Society guidelines.
    1. Williams I, Churchill D, Anderson J, Boffito M, Bower M, Cairns G, et al. British HIV Association guidelines for the treatment of HIV-1-positive adults with antiretroviral therapy 2012 (Updated November 2013. All changed text is cast in yellow highlight.) HIV Med. 2014;15:1–85. doi: 10.1111/hiv.12110. - DOI - PubMed
    1. Ananworanich J, Schuetz A, Vandergeeten C, Sereti I, De Souza M, Rerknimitr R, et al. Impact of multi-targeted antiretroviral treatment on gut T cell depletion and HIV reservoir seeding during acute HIV infection. PLoS One. 2012;7:e33948. doi: 10.1371/journal.pone.0033948. - DOI - PMC - PubMed