13th Annual Conference of the British HIV Association 29 March–1 April 2007, Brighton, UK

EARLY PRIMARY HIV INFECTION (PHI): CLINICAL PRESENTATION AND INFLUENCE OF EARLY HAART ON OUTCOME

HIV Med 2007; 8(Suppl. 1):14 (abstract no. P16)

Pierre Pellegrino², Joanna Turner¹, Andrew Copas¹, Diana Aldam¹, David Cornforth¹ and Ian Williams^1
1Centre for Sexual Health and HIV Research, UCL, London, UK, ²Camden NHS Primary Care Trust, London, UK

OBJECTIVES: To describe the clinical characteristics and outcome of a cohort of patients with early PHI.

METHODS: Prospective cohort study of patients with early PHI. Entry criteria: evolving HIV Ab or -ve HIV Ab test with detectable viral antigen. Patients underwent protocol-scheduled clinical, virological and immunological assessments.

RESULTS: Between 07/1998 and 01/2007, 51 male patients were enrolled, median (range) age: 33 years (22–56), homosexual: 50. Median follow-up: 45.9 months (0.7–102.1). Lost to follow-up: 11.8% (6/51). Time from onset of symptoms (DOS) to diagnosis: median 8 days (0–43), duration of symptoms: median 30 days (3–106), fever: 70.6%, lethargy: 66.7%, pharyngitis: 56.9%, rash: 49%. At diagnosis: plasma HIV RNA: median 440,000 copies/mL (9,200–147,640,000), CD4: median 440×10⁶/l (180–1540). Genotypic resistance: NRTI: 6/51 (11%), NNRTI: 2/51 (3.9%), PI: 2.0%. 12/51 (23.5%) also had an acute bacterial STI. 14/51 (27.4%) started HAART within 60 DOS, and were treated for a median 245 days (11–1107). In a provisional analysis and correcting for duration of follow-up, the rate of CD4 progression (confirmed <350 ×10⁶/l beyond first 60 DOS) was slightly lower in patients treated during PHI (n: 14) compared to those who were not (n: 37): RR: 0.75 (95% CI: 0.29–1.95). 1/51 (1.9%) patient progressed to AIDS (KS).

CONCLUSION: The majority with early PHI were symptomatic and a significant proportion had a co-incident acute STI. The incidence of transmitted resistance is similar to that reported nationally. Although not randomized, in this prospective study there was little evidence of a beneficial effect of HAART treatment during PHI after 4 years of follow-up.

2007-03-29
P16

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