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IAS 2013: Acute Retroviral Syndrome Linked to HIV Disease Progression

People who reported higher scores on a scale of symptom severity during initial HIV infection had lower CD4 T-cell counts, higher viral load set-points, and greater likelihood of HIV disease progression than those with mild or no acute antiretroviral symptoms, researchers reported at the recent 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013) in Kuala Lumpur.

Many people have no symptoms when they first become infected with HIV, but other experience an "acute antiretroviral syndrome" characterized by fever, fatigue, swollen lymph nodes, and other "flu-like" symptoms. Some have more severe illness that may include neurological symptoms or liver inflammation.

A growing body of evidence suggests that antiretroviral therapy (ART) started during primary HIV infection may help prevent immune system damage and put people in a better position to benefit from a potential future functional cure.

Investigators with the Zurich Primary HIV Infection Study Group developed and analyzed a new "Acute Retroviral Syndrome Severity Score" (ARSSS) and its relation to surrogate markers associated with disease progression during and after primary infection.A risk-based scoring system could be helpful in stratifying patients who might benefit from early ART, they suggested.

The researchers enrolled 290 individuals with documented primary HIV infection at a single center in Switzerland in a non-randomized, open-label, observational study. More than 90% were men and the average age was 36 years. 83% were classified as having acute infection while 17% had recent infection.

For each participant, they calculated an ARSSS, ranging from 0 to 10 points, which included the following parameters:

• Severe neurological symptoms: 3 points;
• Need for in-patient care: 3 points;
• Age 50 years or older: 1 point;
• Fever: 1 point;
• Elevated ALT or AST liver enzymes: 1 point;
• Thrombocytopenia (platelet count < 150): 1 point.

They then used linear regression models to evaluate the impact of ARSSS on viral load and CD4 count at baseline, as well as viral set-point, or viral load measured at least 90 days after estimated time of infection or treatment interruption.

Results

• The overall median ARSSS was 2.89.
• Participants with a high ARSSS at baseline had significantly lower CD4 counts and higher HIV RNA levels.
• In a regression model, 1 point higher in ARSSS corresponded to a 0.17 log increase in baseline viral load and a CD4 decline of 12 cells/mm³.
• Among untreated participants (n=64), individuals with a high ARSSS had a significantly higher viral set-point.
• Among participants who started early ART (n=40), however, there was no significant correlation between ARSSS and viral set-point after structured treatment interruption.

"The novel ARSSS is a simple clinical score that correlates with surrogate markers of HIV-1 disease progression," the researchers concluded. "Patients with a high ARSSS should strongly be considered for immediate antiretroviral treatment." 

8/1/13

Reference

DL Braun, R Kouyos, C Grube, et al (Zurich Primary HIV Infection Study Group). A novel acute retroviral syndrome severity score predicts surrogate markers associated with HIV-1 disease progression. 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention. Kuala Lumpur, June 30-July 3, 2013. Abstract TUPE252.