AEGiS-11IAC: Rapid viral load decrease in primary infection associated with aggressive therapy.

11th International AIDS Conference

Vancouver, British Columbia — July 7-12, 1996

Rapid viral load decrease in primary infection associated with aggressive therapy.

Int Conf AIDS 1996 Jul 7-12; 11:26 (abstract no. LB.B.6021)
Workman C, Downie J, Sutherland D, Smith DE, Dyer W, Shen J, Sullivan J; Primary Care Physician, New South Wales, Australia. Fax: 61-2-331-1833. E-mail: lchan@extro.ucc.su.oz.au.

OBJECTIVE: Recent studies suggest that the viral burden reached at the resolution of primary infection may determine disease outcome. Decreasing the viral burden at this early stage of disease is therefore of potential benefit. Greatest decreases in HIV viral burden have been reported using combination therapy that includes a protease inhibitor. In an attempt to achieve this decrease, such therapy was instituted, prior to ELISA positivity, in a 35 y.o. male presenting with a four day history of severe seroconversion illness. Method: Therapy was initiated (AZT) 500 mg, 3TC 600 mg, saquinavir 7200 mg, at 26 days post exposure; d4T 80 mg added at 53 days later. RNA PCR (Amplicor), Western Blot (WB) and lymphocyte subsets assays were performed for three days prior to treatment, then twice weekly for two weeks, then weekly.

RESULTS: Seroconversion symptoms resolved in five days. Therapy was extremely well-tolerated. Viral burden decreased rapidly from 3.2 x 10(6) HIV RNA/ml on Day 0 (pre-therapy) to 2.0 x 10(3) at Week 4, then 4.0 x 10(2) at Week 7. Viral levels continued to drop and were below detection at Week 10, remaining below detection on all subsequent testing (Weeks 11-17). The WB pattern is highly unusual. Bands were slow to register and intensities slow to increase. Bands developed in the following order; p18 at week 4 post-therapy (PT); p24, gp120, gp160 (week 7 PT); p34 (week 12 PT); gp41 (week 16 PT). To date (Week 18) p68 has failed to register. Only four bands (18/160/55/24) continued to intensify with a further ten-week delay to maximal intensity. P34 continues to fluctuate between + and +/-. CD4 mean post-treatment (794) was 220 higher than pre-treatment (574). CD4 median post-treatment (860) was 300 higher than pre-treatment (560).

CONCLUSION: A greater than 6-log decrease in viral burden was observed in this patient treated with potent therapy. The incomplete WB pattern may be a result of this rapid lowering of viral load. The magnitude and rate of viral load decline seen in this patient are greater than previously reported in untreated seroconverters and those treated with therapeutic regimens lacking a protease inhibitor.

960707
LBB6021