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Impact of antiretroviral therapy during acute or early HIV infection on virologic and immunologic outcomes: results from a multinational clinical trial.
Crowell, Trevor A; Ritz, Justin; Zheng, Lu; Naqvi, Asma; Cyktor, Joshua C; Puleo, Joseph; Clagett, Brian; Lama, Javier R; Kanyama, Cecilia; Little, Susan J; Cohn, Susan E; Riddler, Sharon A; Collier, Ann C; Heath, Sonya L; Tantivitayakul, Pornphen; Grinsztejn, Beatriz; Arduino, Roberto C; Rooney, James F; van Zyl, Gert U; Coombs, Robert W; Fox, Lawrence; Ananworanich, Jintanat; Eron, Joseph J; Sieg, Scott F; Mellors, John W; Daar, Eric S.
Afiliación
  • Crowell TA; U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring.
  • Ritz J; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland.
  • Zheng L; Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
  • Naqvi A; Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
  • Cyktor JC; University of Pittsburgh, Pittsburgh, Pennsylvania.
  • Puleo J; University of Pittsburgh, Pittsburgh, Pennsylvania.
  • Clagett B; Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
  • Lama JR; Case Western Reserve University, Cleveland, Ohio, USA.
  • Kanyama C; Asociación Civil Impacta Salud y Educación, Lima, Peru.
  • Little SJ; University of North Carolina Project, Lilongwe, Malawi.
  • Cohn SE; University of California San Diego, San Diego, California.
  • Riddler SA; Northwestern University Feinberg School of Medicine, Chicago, Illinois.
  • Collier AC; University of Pittsburgh, Pittsburgh, Pennsylvania.
  • Heath SL; University of Washington, Seattle, Washington.
  • Tantivitayakul P; University of Alabama @ Birmingham, Birmingham, Alabama, USA.
  • Grinsztejn B; SEARCH Foundation, Bangkok, Thailand.
  • Arduino RC; Institute de Pesquisa Clinica Evandro Chagas, Rio de Janeiro, Brazil.
  • Rooney JF; McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas.
  • van Zyl GU; Gilead Sciences, Foster City, California, USA.
  • Coombs RW; Stellenbosch University, Cape Town, South Africa.
  • Fox L; University of Washington, Seattle, Washington.
  • Ananworanich J; Division of AIDS, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA.
  • Eron JJ; Amsterdam UMC, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.
  • Sieg SF; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
  • Mellors JW; Case Western Reserve University, Cleveland, Ohio, USA.
  • Daar ES; University of Pittsburgh, Pittsburgh, Pennsylvania.
AIDS ; 38(8): 1141-1152, 2024 07 01.
Article en En | MEDLINE | ID: mdl-38489580
ABSTRACT

OBJECTIVE:

To assess how antiretroviral therapy (ART) initiation during acute or early HIV infection (AEHI) affects the viral reservoir and host immune responses.

DESIGN:

Single-arm trial of ART initiation during AEHI at 30 sites in the Americas, Africa, and Asia.

METHODS:

HIV DNA was measured at week 48 of ART in 5 million CD4 + T cells by sensitive qPCR assays targeting HIV gag and pol . Peripheral blood mononuclear cells were stimulated with potential HIV T cell epitope peptide pools consisting of env , gag , nef, and pol peptides and stained for expression of CD3, CD4, CD8, and intracellular cytokines/chemokines.

RESULTS:

From 2017 to 2019, 188 participants initiated ART during Fiebig stages I ( n  = 6), II ( n  = 43), III ( n  = 56), IV ( n  = 23), and V ( n  = 60). Median age was 27 years (interquartile range 23-38), 27 (14%) participants were female, and 180 (97%) cisgender. Among 154 virally suppressed participants at week 48, 100% had detectable HIV gag or pol DNA. Participants treated during Fiebig I had the lowest HIV DNA levels ( P  < 0.001). Week 48 HIV DNA mostly did not correlate with concurrent CD4 + or CD8 + T cell HIV-specific immune responses (rho range -0.11 to +0.19, all P  > 0.025). At week 48, the magnitude, but not polyfunctionality, of HIV-specific T cell responses was moderately reduced among participants who initiated ART earliest.

CONCLUSION:

Earlier ART initiation during AEHI reduced but did not eliminate the persistence of HIV-infected cells in blood. These findings explain the rapid viral rebound observed after ART cessation in early-treated individuals with undetectable HIV DNA by less sensitive methods.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Infecciones por VIH Límite: Adult / Female / Humans / Male País/Región como asunto: Africa / Asia Idioma: En Revista: AIDS Asunto de la revista: SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS) Año: 2024 Tipo del documento: Article Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Infecciones por VIH Límite: Adult / Female / Humans / Male País/Región como asunto: Africa / Asia Idioma: En Revista: AIDS Asunto de la revista: SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS) Año: 2024 Tipo del documento: Article Pais de publicación: Reino Unido