Early HAART Does Not Appear to Lower Virological Set Point

The use of highly active antiretroviral therapy (HAART) during primary (acute) HIV infection in treatment-naïve patients does not appear to lower the virological set point when HAART is interrupted, according to French researchers.

Nevertheless, the results need to be interpreted with caution, lead investigator Dr. Loic Desquilbet of INSERM-INED, Paris, told Reuters Health. "The study was strictly designed to examine the ability of early transient HAART to achieve a lower viremia after treatment interruption than during the natural history of the infection. The impact of early therapy on the dynamics of CD4 cell count after stopping HAART remains to be addressed."

Dr. Desquilbet and colleagues retrospectively studied data from 58 patients treated with HAART during primary HIV infection. They had sustained virological responses until HAART interruption. This group was compared with another 116 untreated patients enrolled in a trial within 6 months of HIV infection.

In the treatment group, mean HIV RNA levels at 36 months (12 months after HAART interruption) were independently associated with levels at HAART initiation and with CD4 cell count at interruption. However, viremia was not associated with the timing of HAART or the duration of virological response to HAART.

HIV RNA levels were 3.95 log10 copies per mL in the treatment group. In never-treated patients, values were similar (4.11 log10 copies per mL), the researchers report in the December 3rd issue of AIDS.

Thus, concluded Dr. Desquilbet, "the study did not provide strong evidence that it is necessary to treat patients diagnosed during primary HIV-1 infection -- at least with current antiretroviral therapies -- with the sole aim of reducing viremia in plasma, compared to the expected level of viremia without any treatment."

01/31/05

AIDS 2004;18:2361-2369.