Since
the advent of potent antiretroviral
therapy in the mid-1990s, researchers have debated the value of early treatment.
Proponents of the "hit early, hit hard" philosophy have suggested that
starting therapy at the earliest stages of infection might lower the viral load
"set-point" (level of stabilization), but others favors delaying therapy
in order to reduce long-term
drug side effects.
As
reported in the June 1, 2007 Journal of Acquired Immune Deficiency Syndromes,
researchers with the CASCADE Collaboration investigated the effect of a short
course of HAART during primary HIV infection (PHI) on the rate of changes in CD4
cell count and viral load.
The
study included 89 patients who seroconverted between 1999 and 2003 and chose to
begin a 3-month course of combination
HAART during primary infection, as well as 179 untreated control subjects.
Participants were non-randomized, but were matched for age, sex, HIV risk factors,
year of seroconversion, and presentation within the first 6 months after seroconversion.
Results
• The rate of
CD4 cell decline following treatment cessation appeared significantly slower among
treated participants compared with untreated control subjects.
•
3 years after seroconversion, CD4 cell counts had declined by
51 cells/mm3 in the treated patients, compared with 77 cells/mm3 in the untreated
subjects (P = 0.011).
•
After 2 years, there was no significant difference in mean viral
load levels between the treated and untreated subjects (4.31 vs 4.47 copies/mL,
respectively).
• However,
after 3 years, based on extrapolated data, viral loads did differ significantly
(4.09 vs 4.53 copies/mL, respectively).
•
Untreated seroconverters were more likely to reach CD4 cell
counts below 350 cells/mm3 or to initiate clinically indicated antiretroviral
therapy.
Conclusion
"A
short course of antiretroviral therapy at PHI may delay CD4 cell decline,"
the authors concluded.
They
added that, "Confirmation of this requires a randomized clinical trial powered
to address definitively the role of antiretroviral therapy intervention in PHI."
Such a study, dubbed SPARTAC, is currently underway.
07/03/07
Reference S
Fidler, J Fox, G Touloumi, and others (CASCADE Collaboration). Slower CD4 cell
decline following cessation of a 3 month course of HAART in primary HIV infection:
findings from an observational cohort. AIDS 21(10): June 2007. 1283-1291.
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Since
the advent of potent 
