OBJECTIVE: To investigate the effect of a short course of HAART during primary HIV infection (PHI) on rate of CD4 cell and viral load change. METHODS: Data following HAART cessation from 89 individuals (seroconverting 1999-2003) who chose to take a 3 month course of HAART at PHI were compared with 179 untreated controls in CASCADE, using linear and nonlinear random effects models. Participants were non-randomized but frequency matched for age, sex, risk factor, year of seroconversion and presentation within the first 6 months of seroconversion. Time to CD4 cell count < 350 cells/microl and initiation of clinically indicated antiretroviral therapy (ART) were also compared as competing risks. RESULTS: The rate of CD4 cell decline following therapy cessation appeared significantly slower among treated participants than untreated controls: losses of 51 cells/microl [95% confidence interval (CI), 32-69] and 77 cells/microl (95% CI, 65-89), respectively, 3 years after seroconversion (P = 0.011). Based on extrapolated data, viral loads also differed significantly at this point (4.09 and 4.53 copies/ml, respectively). At 2 years, there was no significant difference in mean viral load levels: 4.31 copies/ml (95% CI, 4.14-4.48) and 4.47 copies/ml (95% CI, 4.28-4.66), respectively. CASCADE seroconverters were more likely to reach CD4 cell count < 350 cells/microl or initiate clinically indicated ART (hazard ratio, 1.45; 95% CI, 1.02-2.05; P = 0.039). CONCLUSION: A short course of ART at PHI may delay CD4 cell decline. Confirmation of this requires a randomized clinical trial powered to address definitively the role of ART intervention in PHI (currently underway through SPARTAC).
OBJECTIVE: To investigate the effect of a short course of HAART during primary HIV infection (PHI) on rate of CD4 cell and viral load change. METHODS: Data following HAART cessation from 89 individuals (seroconverting 1999-2003) who chose to take a 3 month course of HAART at PHI were compared with 179 untreated controls in CASCADE, using linear and nonlinear random effects models. Participants were non-randomized but frequency matched for age, sex, risk factor, year of seroconversion and presentation within the first 6 months of seroconversion. Time to CD4 cell count < 350 cells/microl and initiation of clinically indicated antiretroviral therapy (ART) were also compared as competing risks. RESULTS: The rate of CD4 cell decline following therapy cessation appeared significantly slower among treated participants than untreated controls: losses of 51 cells/microl [95% confidence interval (CI), 32-69] and 77 cells/microl (95% CI, 65-89), respectively, 3 years after seroconversion (P = 0.011). Based on extrapolated data, viral loads also differed significantly at this point (4.09 and 4.53 copies/ml, respectively). At 2 years, there was no significant difference in mean viral load levels: 4.31 copies/ml (95% CI, 4.14-4.48) and 4.47 copies/ml (95% CI, 4.28-4.66), respectively. CASCADE seroconverters were more likely to reach CD4 cell count < 350 cells/microl or initiate clinically indicated ART (hazard ratio, 1.45; 95% CI, 1.02-2.05; P = 0.039). CONCLUSION: A short course of ART at PHI may delay CD4 cell decline. Confirmation of this requires a randomized clinical trial powered to address definitively the role of ART intervention in PHI (currently underway through SPARTAC).
Authors: Christine M Hogan; Victor Degruttola; Xin Sun; Susan A Fiscus; Carlos Del Rio; C Bradley Hare; Martin Markowitz; Elizabeth Connick; Bernard Macatangay; Karen T Tashima; Beatrice Kallungal; Rob Camp; Tia Morton; Eric S Daar; Susan Little Journal: J Infect Dis Date: 2011-12-15 Impact factor: 5.226
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Authors: C Koegl; E Wolf; N Hanhoff; H Jessen; K Schewe; M Rausch; J Goelz; A Goetzenich; H Knechten; H Jaeger; W Becker; I Becker-Boost; D Berzow; B Beiniek; J Brust; D Shcuster; S Dupke; S Fenske; H J Gellermann; R Gippert; P Hartmann; B Hintsche; H Jaeger; E Jaegel-Guedes; H Jessen; J Gölz; J Koelzsch; E B Helm; G Knecht; H Knechten; I Lochet; P Gute; S Mauruschat; S Mauss; V Miasnikov; F A Mosthaf; M Rausch; M Freiwald; B Reuter; H M Schalk; B Schappert; E Schnaitmann; I Schneider; W Schüler-Maué; C Schuler; T Seidel; W Starke; A Ulmer; M Müller; I Weitner; K Schewe; C Zamani; A Hanmond; K Ross; A Bottlaender; C Hoffmann; A Dix; A Schneidewind; M Lademann Journal: Eur J Med Res Date: 2009-07-22 Impact factor: 2.175
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