Does Early Treatment of Primary HIV Infection Delay Treatment Indication?

The scientific data on optimal management of primary HIV infection are inconclusive. There is poor evidence that treatment of primary HIV infection can reduce the viral load set point and thereby delay disease progression.

The primary endpoint of the current study was the time to CD4-decline to <350/µl and/or VL-increase to >100,000 cop/ml in treated and untreated seroconverters.

The researchers analyzed two prospective national cohorts of seroconverters:

1) Prime-DAG started in July 2001 with a focus on early treatment; and

2) Ac-DAG started in January 2003 with a focus on non-treatment of primary HIV-infection.

Criteria for primary HIV-infection were either a negative ELISA, coupled with a positive viral load (VL), or a documented western blot with less than 5 bands.

Results

200 (191 male) cases of primary HIV-infection have been reported. In 144 patients (pts), treatment was started immediately, 56 pts remained untreated.

In pts without treatment, the median first measured viral load was 240,000 cop/ml versus 500,000 cop/ml in pts initiating treatment (p<0.001).

The median CD4 counts were 629/µl and 453/µl respectively (p=0.001). 98/144 treated pts stopped treatment after a median time of 9.0 months.

At this point, VL was below detection in 81% of these pts (range: <49 - 7.300 cop/ml).

The median CD4 count was 803/µl. 37 of those discontinuing treatment (38%) reached the primary endpoint after a median treatment interruption of 14.3 months.

In 20/56 untreated pts (36%), the primary endpoint was reached after a median observation time of 8.3 months after seroconversion (p=0.02).
Using Kaplan-Meier analysis (treatment (re-)start was censored in case of CD4>350 or VL<100.000), the primary endpoint was only significant for pts with a first measured VL of >50,000 cop/ml (Breslow-Gehan, p=0.02).

The authors conclude, "Our cohort shows a trend where early treatment of primary HIV infection delays the time until treatment indication in patients presenting with a viral load VL >50,000 cop/ml during seroconversion.

MUC Research, Science, Munich, Germany, MUC Research, Munich, Germany, Private Practice, Berlin, Germany, Practice St. Georg, Hamburg, Germany, Private HIV Practice, Berlin, Germany, Practice Centre Kaiserdamm, Berlin, Germany, DAGNAE e.V., Aachen, Germany, HIV Research and Clinical Care Centre Munich, Munich, Germany.

08/18/06

Reference
C Koegl, E Wolf, H Jessen, and others. Does early treatment of primary HIV-infection delay treatment indication? 16th International AIDS Conference; August 13-18, 2006; Toronto, Canada. Abstract MOPE0060.