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Medline ® Abstract for Reference 24

of 'Acute and early HIV infection: Treatment'

Effect of treatment, during primary infection, on establishment and clearance of cellular reservoirs of HIV-1.
Strain MC, Little SJ, Daar ES, Havlir DV, Gunthard HF, Lam RY, Daly OA, Nguyen J, Ignacio CC, Spina CA, Richman DD, Wong JK
J Infect Dis. 2005;191(9):1410.
Patients in whom virologic suppression is achieved with highly active antiretroviral therapy (HAART) retain long-lived cellular reservoirs of human immunodeficiency virus type 1 (HIV-1); this retention is an obstacle to sustained control of infection. To assess the impact that initiating treatment during primary HIV-1 infection has on this cell population, we analyzed the decay kinetics of HIV-1 DNA and of infectivity associated with cells activated ex vivo in 27 patients who initiated therapy before or<6 months after seroconversion and in whom viremia was suppressed to<50 copies/mL. The clearance rates of cellular reservoirs could not be distinguished by these techniques (median half-life, 20 weeks) during the first year of HAART. The clearance of HIV-1 DNA slowed significantly during the subsequent 3 years of treatment (median half-life, 70 weeks), consistent with heterogeneous cellular reservoirs being present. Total cell-associated infectivity (CAI) after 1 year of treatment was undetectable (<0.07 infectious units/million cells [IUPM]) in most patients initiating treatment during primary infection either before (9/9) or<6 months after (6/8) seroconversion. In contrast, all 17 control patients who initiated HAART during chronic infection retained detectable CAI after 3-6 years of treatment (medianreservoir size, 1.1 IUPM; P<.0005). These results suggest that treatment<6 months after seroconversion may facilitate long-term control of cellular reservoirs that maintain HIV-1 infection during treatment.
Department of Physics, University of California at San Diego, La Jolla, California, USA.