BACKGROUND: Treatment of acute human immunodeficiency virus type 1 (HIV-1) infection may have unique immunologic, virological, and clinical benefits. However, the timing of treatment, optimal starting regimens, and expected response to therapy have not been defined.Methods. One hundred two subjects treated during acute and early HIV-1 infection were observed prospectively to determine the effect of time elapsed before initiation of therapy on time to virological suppression and absolute CD4+ cell count. Subjects were divided into pre- and postseroconversion groups on the basis of HIV-1 antibody status at the time of initiation of treatment. Absolute CD4+ cell counts were compared between these groups and with those of historical untreated persons who had experienced seroconversion. Potential predictors of time to virological suppression and CD4+ cell count at > or =12 months were assessed. RESULTS: Ninety-nine (97%) of 102 subjects achieved virological suppression. The median time to suppression was 11.1 weeks (95% confidence interval, 9.4-14.9) and was independent of initial regimen. The mean CD4+ cell count at 12 months was 702 cells/mm3 (95% confidence interval, 654-750 cells/mm3) and showed an increasing trend over 60 months. Treated subjects demonstrated a statistically significant gain in the CD4+ cell count, compared with untreated historical control subjects, at > or =12 months. Comparable virological and immunologic outcomes were seen in the pre- and postseroconversion groups. Baseline virus load and nadir CD4+ cell count predicted time to virological suppression and CD4+ cell count at > or =12 months, respectively. CONCLUSIONS: Early treatment of HIV-1 infection is well tolerated and results in rapid and sustained virological suppression. Preservation of CD4+ cell counts may be achieved with early therapy, independent of seroconversion status. Protease inhibitor-based and nonnucleoside reverse-transcriptase inhibitor-based regimens show comparable performance in tolerability, time to virological suppression, and CD4+ cell count when used as a first regimen.
BACKGROUND: Treatment of acute human immunodeficiency virus type 1 (HIV-1) infection may have unique immunologic, virological, and clinical benefits. However, the timing of treatment, optimal starting regimens, and expected response to therapy have not been defined.Methods. One hundred two subjects treated during acute and early HIV-1 infection were observed prospectively to determine the effect of time elapsed before initiation of therapy on time to virological suppression and absolute CD4+ cell count. Subjects were divided into pre- and postseroconversion groups on the basis of HIV-1 antibody status at the time of initiation of treatment. Absolute CD4+ cell counts were compared between these groups and with those of historical untreated persons who had experienced seroconversion. Potential predictors of time to virological suppression and CD4+ cell count at > or =12 months were assessed. RESULTS: Ninety-nine (97%) of 102 subjects achieved virological suppression. The median time to suppression was 11.1 weeks (95% confidence interval, 9.4-14.9) and was independent of initial regimen. The mean CD4+ cell count at 12 months was 702 cells/mm3 (95% confidence interval, 654-750 cells/mm3) and showed an increasing trend over 60 months. Treated subjects demonstrated a statistically significant gain in the CD4+ cell count, compared with untreated historical control subjects, at > or =12 months. Comparable virological and immunologic outcomes were seen in the pre- and postseroconversion groups. Baseline virus load and nadir CD4+ cell count predicted time to virological suppression and CD4+ cell count at > or =12 months, respectively. CONCLUSIONS: Early treatment of HIV-1 infection is well tolerated and results in rapid and sustained virological suppression. Preservation of CD4+ cell counts may be achieved with early therapy, independent of seroconversion status. Protease inhibitor-based and nonnucleoside reverse-transcriptase inhibitor-based regimens show comparable performance in tolerability, time to virological suppression, and CD4+ cell count when used as a first regimen.
Authors: Toshiyuki Miura; Zabrina L Brumme; Mark A Brockman; Pamela Rosato; Jennifer Sela; Chanson J Brumme; Florencia Pereyra; Daniel E Kaufmann; Alicja Trocha; Brian L Block; Eric S Daar; Elizabeth Connick; Heiko Jessen; Anthony D Kelleher; Eric Rosenberg; Martin Markowitz; Kim Schafer; Florin Vaida; Aikichi Iwamoto; Susan Little; Bruce D Walker Journal: J Virol Date: 2010-05-26 Impact factor: 5.103
Authors: Sagar A Vaidya; Christian Korner; Michael N Sirignano; Molly Amero; Sue Bazner; Jenna Rychert; Todd M Allen; Eric S Rosenberg; Ronald J Bosch; Marcus Altfeld Journal: J Infect Dis Date: 2014-03-31 Impact factor: 5.226
Authors: Margaret R Lentz; Woong-Ki Kim; Hyun Kim; Caroline Soulas; Vallent Lee; Nagagopal Venna; Elkan F Halpern; Eric S Rosenberg; Kenneth Williams; R G González Journal: J Neurovirol Date: 2011-04-15 Impact factor: 2.643
Authors: Cynthia L Gay; Ashley J Mayo; Chelu K Mfalila; Haitao Chu; Anna C Barry; JoAnn D Kuruc; Kara S McGee; Melissa Kerkau; Joe Sebastian; Susan A Fiscus; David M Margolis; Charles B Hicks; Guido Ferrari; Joseph J Eron Journal: AIDS Date: 2011-04-24 Impact factor: 4.177
Authors: Eric S Rosenberg; Barney S Graham; Ellen S Chan; Ronald J Bosch; Vicki Stocker; Janine Maenza; Martin Markowitz; Susan Little; Paul E Sax; Ann C Collier; Gary Nabel; Suzanne Saindon; Theresa Flynn; Daniel Kuritzkes; Dan H Barouch Journal: PLoS One Date: 2010-05-10 Impact factor: 3.240
Authors: Kimberly A Powers; William C Miller; Christopher D Pilcher; Clement Mapanje; Francis E A Martinson; Susan A Fiscus; David A Chilongozi; David Namakhwa; Matthew A Price; Shannon R Galvin; Irving F Hoffman; Myron S Cohen Journal: AIDS Date: 2007-10-18 Impact factor: 4.177
Authors: Lena Al-Harthi; Sam MaWhinney; Elizabeth Connick; Robert T Schooley; Jeri E Forster; Constance Benson; Melanie Thompson; Franklyn Judson; Frank Palella; Alan Landay Journal: Clin Immunol Date: 2007-10-03 Impact factor: 3.969
Authors: Katie E Mosack; Lance S Weinhardt; Jeffrey A Kelly; Cheryl Gore-Felton; Timothy L McAuliffe; Mallory O Johnson; Robert H Remien; Mary Jane Rotheram-Borus; Anke A Ehrhardt; Margaret A Chesney; Stephen F Morin Journal: Behav Med Date: 2009 Impact factor: 3.104