14th International AIDS Conference


Barcelona, Spain — July 7-12, 2002
[TITLE:] Immunological and virological effects of short course antiretroviral therapy in primary HIV infection

[AUTHOR(S):] S J Fidler, M D Brady, N Weber1, A Oxenius, D Price, H T Zhang, R Phillips2, A Babiker3

Int Conf AIDS. 2002 Jul 7-12;14:Abstract No. TuOrB1185

[ABSTRACT:] Aim: This project aims to evaluate whether a short course of antiretroviral therapy (SCART) given at acute HIV infection is sufficient to preserve HIV specific CD4+ T-helper responses otherwise lost in the absence of intervention.

Background: National and international guidelines call for treatment of primary HIV infection (PHI) with Antiretroviral therapy (ART). The nature, optimal timing and duration of this intervention remains unclear. A short course of treatment has the additional benefit of avoidance of longterm toxicity, and development of drug resistance with the potential application to resource poor settings where longterm treatment is unfeasible.

METHODS: 45 subjects identified with PHI were recruited and offered a choice to commence SCART or receive no treatment. HIV specific CD8 and CD4 T-cell responses were analysed using ELISPOT technology. Monthly pVL and CD4 counts were quantified.

RESULTS: All subjects receiving therapy achieved a plasma viral load (pVL) of <50 copies RNA/ml by median 12 weeks (range 4-32 weeks). 3/45 individuals had evidence of genotypic drug resistance at baseline, and none developed de novo drug resistance mutations following therapy. Patients that chose SCART at PHI showed preservation of HIV specific CD4 T-helper responses. The average pVL more than 21 weeks off SCART was significantly lower than baseline (mean drop 0.5 log HIV RNA copies RNA/ml p=0.05) Average CD4 T-cell coutn more than 1 weeks off SCAT was 160 cells/mm3 highre than at baseline (sign rank test p=0.05).

CONCLUSIONS: Early SCART was safe and associated with a preservation of HIV specific immune responses. However, PHI is highly heterogeneous, with wide variations in virological and immunological parameters and a large scale randomised trial of ART at PHI is now needed.

Presenting author: Sarah Fidler

1Imperial College Faculty of Medicine, Wright Fleming Institute Dept GUM/HIV Faculty of Medicine, Imperial college St Mary's Hospital, London W2 1NY, United Kingdom

2University of Oxford, Oxford

3University of Oxford, oxford, United Kingdom

4Medical Research Council Clinical Trial Centre, London

Download Presentation

020707
TuOrB1185

Copyright © 2002 - International AIDS Society (IAS). Reproduction of this abstract (other than one copy for personal reference) must be cleared through the IAS.