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ART Initiation During Early HIV Infection Associated With Improved Immunologic, Virologic Parameters: Presented at CROI

By Cheryl Lathrop

BOSTON -- March 4, 2011 -- Antiretroviral therapy (ART) initiation in the first 6 months of infection may be associated with lower on-therapy T-cell activation levels and smaller HIV reservoirs compared with delayed ART initiation, researchers said here on February 28 at the 18th Conference on Retroviruses and Opportunistic Infections (CROI).

If ART is initiated during chronic infection (rather than during acute infection), CD4+ and CD8+ T-cell activation levels often remain elevated. This persistent inflammatory state has been associated with blunted CD4+ T-cell recovery and early mortality during suppressive ART.

The relationship of the timing of ART initiation with the on-ART levels of inflammation and with the size of the persistent viral reservoir is not fully understood.

Vivek Jain, MD, San Francisco General Hospital, and the University of California, San Francisco, San Francisco, California, compared T-cell activation among individuals with acute/early HIV infection (<6 months) who started ART early (<6 months after estimated date of HIV infection; n = 34) versus those who began ART later (·2 years; n = 32) and who maintained ·2 years of subsequent virologic suppression.

At-risk uninfected persons served as controls (they sought HIV testing, had negative results, and attended 2 study visits).

The later ART group had a higher frequency of activated CD8+ T cells on-ART compared with the early ART group (P =.009). Similarly, later ART had a higher frequency of activated CD4+ T cells than early ART (P =.06).

Although early ART patients had better on-ART CD8+ T-cell activation levels, these levels remained elevated compared with HIV-negative controls (P =.02 and P =.01 for early ART vs HIV-negative and late ART vs HIV-negative, respectively).

The persistent T-cell activation associated with deferred ART was observed in central memory T-cell subsets. Deferred therapy was associated with a 4.8-fold higher level of proviral DNA (P =.0045) and 3.2 S/Co units higher cell-associated RNA (P =.035).

[Presentation title: ART Initiation During Acute/Early HIV Infection Compared to Later ART Initiation Is Associated With Improved Immunologic and Virologic Parameters During Suppressive ART. Abstract 517]

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