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Clin Infect Dis. (2015) doi: 10.1093/cid/civ171First published online: March 3, 2015
Impact of the Earliness of Antiretroviral Therapy Initiation During Primary HIV-1 Infection on the Decay of Cell-Associated HIV-DNA
1Inserm, CESP Centre for Research in Epidemiology and Population Health, U1018, Paris-Sud University, Le Kremlin-Bicêtre, France
2APHP, Department of Epidemiology and Public Health, Bicêtre Hospital, Le Kremlin-Bicêtre, France
Background. Combined antiretroviral therapy (cART) initiation during primary HIV infection (PHI) yields larger decrease in cell-associated HIV-DNA (CA-HIV-DNA) than initiation during the chronic phase. Our objective was to model the short and long-term decay of CA-HIV-DNA blood reservoir in patients initiating cART during PHI and to assess the impact of the earliness of cART initiation on CA-HIV-DNA decay.
Methods. We included patients enrolled during PHI in the ANRS PRIMO cohort, treated within the month following enrollment and achieving sustained virological response. The decay of CA-HIV-DNA over time while on successful cART was modeled with a 3-slope linear mixed-effects model according to the delay between estimated date of infection and cART initiation.
Results. 327 patients were included, accounting for 1,305 CA-HIV-DNA quantifications. Median time between infection and cART initiation was 41 days (IQR: 33-54). Median follow-up under cART was 2.3 years (range: 0.4-16.6). The earliness of cART initiation had significant impact on the first slope of decrease: the earlier cART was initiated after HIV infection, the faster CA-HIV-DNA level decreased during the first 8 months of cART: -0.171, -0.131, and -0.068 log10 copies/106 PBMC/month when cART was initiated 15 days, 1 month and 3 months after infection, respectively.
Conclusions. This study provides strong arguments in favor of cART initiation at the earliest possible time point after HIV infection.