AEGiS-12IAC: Impact of a highly active antiretroviral therapy (HAART) on viral dynamics during primary HIV-1 infection.

12th International AIDS Conference

Geneva, Switzerland - June 28-July 3, 1998

Impact of a highly active antiretroviral therapy (HAART) on viral dynamics during primary HIV-1 infection.

Int Conf AIDS 1998 Jun 28-Jul 3; 12:13 (abstract no. 11155)

Kaufmann GR, Cunningham P, Vizzard J, Carr A, Cooper DA
Center for Immunology, St. Vincent's Hosp, Sydney, Australia.

OBJECTIVES: The application of HAART in primary HIV-1 infection may prevent extensive HIV-1 replication and the subsequent spread of viral particles into all body compartments. We analyzed the influence of an early HAART on viral dynamics in patients with primary HIV-1 infection.

METHODS: Decay rates of viral load, estimated by linear regression, were calculated in patients on indinavir, lamivudine and stavudine (n = 12) and compared with viral kinetic parameters in untreated patients (n = 13) and patients receiving zidovudine (n = 7). Moreover, viral dynamic parameters were compared to those of HIV patients commencing HAART in an asymptomatic stage after primary HIV-1 infection.

RESULTS: Patients with HAART demonstrated a rapid, biphasic linear decay of logarithmic HIV RNA: median slope of the first phase -0.1565 log₁₀ cop/ml/d (interquartile range: -0.1846 to -0.1449), slope of second phase-0.0242 (-0.0299 to -0.0212), viral half life during the first phase 3.7d, half life during the second phase 28.6d. In contrast, patients on nucleoside analogues (NA) demonstrated a significantly slower decrease of viral load during the first phase (P = 0.004), which was similar to the decrease in untreated patients (UP): slope NA -0.0422 (-0.0838 to -0.0374), slope UP: -0.0543 (-0.0917 to -0.0352). Second phase decay of viral load in patients with HAART during primary HIV-1 infection was significantly rmore rapid than in patients on HAART in a later stage of the disease: -0.0242 (-0.0299 to -0.0212) vs -0.0121 (-0.0138 to -0.0093), P = 0.001. After 48 weeks patients treated during primary HIV-1 infection were more likely to have undetectable viral load (< 50 cop/ml) than patients with the same therapy after primary HIV-1 infection (P = 0.001).

CONCLUSION: In contrast to nucleoside analogues, HAART efficiently reduced viral burden in the earliest time of primary HIV-1 infection. Moreover, HAART also more rapidly reduced viral load in the second phase, when administered early in primary HIV-1 infection. The early application of HAART during primary HIV-1 infection may have an advantage over a delayed therapy.

Keywords: AEGIS, Antiretroviral Therapy, Highly Active, HIV Infections, Viral Load, HIV-1, Zidovudine, Indinavir, Stavudine, Virus Replication, Lamivudine, Human, virology, ICA12
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