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

C Koegl, the Prime-DAG and Ac-DAG Study Groups, E Wolf, N Hanhoff, H Jessen, K Schewe, M Rausch, J Goelz, A Goetzenich, H Knechten, H Jaeger
2009 European Journal of Medical Research  
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/µl after treatment stop or seroconversion was calculated using Kaplan-Meier and Cox-PH-regression analyses. Results: 156 cases of PHI were
more » ... d, 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/µl vs. 613/µl; 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/µl vs. -86/µl (p = 0.01). Median time until CD4 lymphocytes decreased to <350/µl (including all patients with CD4 lymphocytes <500/µl 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/µl was significantly shorter in untreated than in treated patients including patients with CD4 lymphocytes <500/µl during seroconversion.
doi:10.1186/2047-783x-14-7-277 fatcat:g3jg3yg4xfeephihesabqdg4cm