AEGiS-11CROI: Effect of Treatment during versus after Acute Retroviral Syndrome (ARS) on HIV Viral Load and CD4 Cell Counts within 3 Years of Infection

11th Conference on Retroviruses and Opportunistic Infections

San Francisco, California - February 8 - 11, 2004

Effect of Treatment during versus after Acute Retroviral Syndrome (ARS) on HIV Viral Load and CD4 Cell Counts within 3 Years of Infection

Conf Retrovir Opportunistic Infect 2004 Feb 8-11;11:abstract no. 23

N Voirin¹, D Smith², J P Routy³, M Legault³, D Baratin⁴, C Trepo^1,5, L Cotte⁵, J M Livrozet⁴, J L Touraine⁴, D A Cooper², A Gayet-Ageron⁴, J Ritter⁴, J Fabry⁴, and P Vanhems^1,4
¹INSERM U271, Lyon, France; ²Univ. of New South Wales, Sydney, Australia; ³McGill Univ., Montreal, Canada; ⁴Edouard Herriot Hosp., Lyon, France; and ⁵Hotel Dieu Hosp., Lyon, France

BACKGROUND: Starting antiretroviral therapy (ART) during ARS might influence immediate immunological response and control of virological replication but it is unknown if this benefit persists over time. We therefore compared the HIV viral load and the CD4 cell counts at different time points from the initiation of ART among patients treated during or treated after ARS.

METHODS: Data from patients enrolled from 1995 to 2003 in 3 prospective primary HIV infection cohorts with similar follow-up (Lyon, Montreal, and Sydney) were analyzed. We compared mean HIV viral load and CD4 counts at initiation of therapy, 6 months and 1, 2, and 3 years after start of therapy between patients with documented ARS treated during or after ARS, using Kruskal-Wallis rank sum test.

RESULTS: Of a total of 203 patients, 188 (93%) were male, mean age 34.5 years. The presumed route of HIV infection was men who had sex with men for 148 (73%), heterosexual contact for 21 (10%), and injecting drug use for 33 (16%). ART was started after ARS for 117 (58%) (Gr1), during ARS for 51 (25%) (Gr2), and 35 (17%) received no therapy during the follow-up (Gr0). The mean time between onset of ARS and start of therapy was 164 days for Gr1 and 27 days (p = 0.001) for Gr2. No difference was observed between the 3 groups for gender (p = 0.65) and age (p = 0.47). The table shows the HIV viral load and CD4 count for each group at the various time points. Similar results persist after adjustment on ARS severity score.


Time from start of therapy	Mean log₁₀ HIV RNA					Mean CD4 count/mm³

	Gr0	Gr1	Gr2	p1*	p2**	Gr0	Gr1	Gr2	p1	p2
Baseline	4.63	4.27	4.58	0.11	0.06	697	540	621	0.10	0.05
6 months	3.91	1.97	1.78	<0.01	0.40	538	662	722	0.01	0.30
1 year	4.24	2.13	1.73	<0.01	0.26	567	657	721	0.11	0.14
2 years	3.84	2.34	2.28	0.03	0.57	468	764	694	0.04	0.76
3 years	4.77	1.01	1.70	0.10	0.09	380	938	693	0.27	0.82

CONCLUSIONS: We observed no beneficial effect of early initiation of therapy on HIV viral load and CD4 cells count over the next 3 years. This suggests that any delay in starting therapy may have only minor effect at 3 years on CD4 cells count and HIV RNA, after taking HAART effectiveness into account. These observational data do not support the urgent initiation of ART in patients with ARS, but randomized clinical trials are needed to conclude.

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Copyright © 2004 - Foundation for Retrovirology and Human Health. Reproduction of this abstract (other than one copy for personal reference) must be cleared through the Foundation for Retrovirology and Human Health. Licensed (AIDSLINE) from National Library of Medicine.