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Original article

Effect of early antiretroviral therapy during primary HIV-1 infection on cell-associated HIV-1 DNA and plasma HIV-1 RNA

Sara Gianella, Viktor von Wyl, Marek Fischer, Barbara Niederoest, Manuel Battegay, Enos Bernasconi, Matthias Cavassini, Andri Rauch, Bernard Hirschel, Pietro Vernazza, Rainer Weber, Beda Joos, Huldrych F Günthard, the Swiss HIV Cohort Study

Corresponding author name: Huldrych F Günthard
Corresponding author e-mail: huldrych.guenthard@usz.ch

Citation: Antiviral Therapy 2011; 16:535-545
doi: 10.3851/IMP1776

Date accepted: 27 October 2010
Date published online: 11 April 2011

Abstract

Background: Early initiation of combination antiretroviral therapy (ART) during primary HIV-1 infection may prevent the establishment of large viral reservoirs, possibly resulting in improved control of plasma viraemia rebound after ART cessation.

Methods: Levels of cell-associated HIV-1 DNA and plasma HIV-1 RNA were measured longitudinally in 32 acutely and recently infected patients, who started ART ≤120 days after the estimated date of infection, and interrupted ART after 18 months (median) of continuous therapy. Averages of HIV-1 DNA and RNA concentrations present in blood 30–365 days after therapy interruption (median duration 300 days, range 195–358) were compared between patients who started ART ≤60 days after the estimated date of infection (early starters), those who started between 61 and 120 days (later starters), and, for HIV-1 RNA only, with 89 untreated participants of the Swiss HIV Cohort Study with documented seroconversion and longitudinal measurements collected 90–455 days after the first positive HIV test.

Results: In early ART starters, average levels of plasma HIV-1 RNA and cell-associated HIV-1 DNA after treatment interruption were 1 log10 (P=0.008) and 0.4 log10 (P=0.03) lower compared with later starters. Average post-treatment plasma HIV-1 RNA levels in early starters were significantly lower, respectively, compared with untreated controls (-1.2 log10; P<0.0004).

Conclusions: Early treatment initiation within 2 months after HIV infection compared with later therapy initiation resulted in reduced levels of plasma viraemia and proviral HIV-1 DNA for ≥1 year after subsequent ART cessation. Plasma HIV-1 RNA levels in early starters were also significantly lower than in untreated controls.

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