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The impact of transient combination antiretroviral treatment in early HIV infection on viral suppression and immunologic response in later treatment

Pantazis, N; Touloumi, G; Meyer, L; Olson, A; Costagliola, D; Kelleher, AD; Lutsar, I; ... CASCADE Collaboration in EuroCoord, ; + view all (2016) The impact of transient combination antiretroviral treatment in early HIV infection on viral suppression and immunologic response in later treatment. AIDS , 30 (6) pp. 879-888. 10.1097/QAD.0000000000000991. Green open access

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Abstract

OBJECTIVE: Effects of transient combination antiretroviral treatment (cART) initiated during early HIV infection (EHI) remain unclear. We investigate whether this intervention affects viral suppression and CD4 cell count increase following its reinitiation in chronic infection (CHI). DESIGN: Longitudinal observational study. METHODS: We identified adult patients from Concerted Action of Seroconversion to AIDS and Death in Europe who seroconverted after 1/1/2000, had a 12 months or less HIV test interval and initiated cART from naive. We classified individuals as 'pretreated in EHI' if treated within 6 months of seroconversion, interrupted for at least 12 weeks, and reinitiated during CHI. Statistical analysis was performed using survival analysis methods and mixed models. RESULTS: Pretreated and initiated in CHI groups comprised 202 and 4263 individuals, with median follow-up after CHI treatment 4.5 and 3 years, respectively. Both groups had similar virologic response and relapse rates (P = 0.585 and P = 0.206) but pretreated individuals restarted treatment with higher baseline CD4 cell count (∼80 cells/μl; P < 0.001) and retained significantly higher CD4 cell count for more than 3 years after treatment (re)initiation. Assuming common baseline CD4 cell count, differences in CD4 cell count slopes were nonsignificant. Immunovirologic response to CHI treatment was not associated with timing or duration of the transient treatment. CONCLUSION: Although treatment interruptions are not recommended, stopping cART initiated in EHI does not seem to reduce the chance of a successful outcome of treatment in CHI.

Type: Article
Title: The impact of transient combination antiretroviral treatment in early HIV infection on viral suppression and immunologic response in later treatment
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1097/QAD.0000000000000991
Publisher version: Http://dx.doi.org/10.1097/QAD.0000000000000991
Language: English
Additional information: This is an open access article distributed under the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/1479523
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