Greater Reversal of CD4⁺ Cell Abnormalities and Viral Load Reduction after Initiation of Antiretroviral Therapy with Zidovudine, Lamivudine, and Nelfinavir before Complete HIV Type 1 Seroconversion

Abstract

In a prospective open-label study, 41 male subjects received nelfinavir, zidovudine, and lamivudine stratified as either: early stage (ES; negative/indeterminate Western blot; n = 19) or late stage (LS; positive Western blot; n = 22) primary HIV-1 infection. Despite higher median baseline HIV-1 RNA levels and lower CD4(+) cell numbers in the ES subjects, a significantly greater decline in viral load (-3.46 vs. -2.83 log(10) copies/ml; p = 0.023) and increase in CD4(+) cell number (+85 vs. +41 cells/month increase, p = 0.01) were observed over the first 3 months of therapy such that both groups had comparable results at 1 year. The proportion with HIV-1 RNA < 50 copies/mL at 1 year was similar (9 of 19 ES subjects and 11 of 22 LS subjects by intention-to-treat analysis). Memory CD4(+) cell numbers, and activated CD4(+) percentages, were also significantly improved in ES subjects. Despite poorer prognostic markers at baseline ES subjects achieved responses similar to those of LS subjects after 1 year of treatment.

Antiretroviral therapy in acute and recent HIV infection: a prospective multicenter stratified trial of intentionally interrupted treatment

“…Most studies of ART treatment interruption in chronic HIV-1 infection have found no virologic benefit16, 17, 18, 19 with one exception where a modest benefit from two interruptions was reported20, nor did the addition of hydroxyurea add benefit21. The strategy of antiretroviral treatment interruption has fallen into disfavor based upon recent findings in chronically HIV-1-infected individuals that interruption of antiretroviral therapy is associated with increased morbidity and mortality22.…”

Progressive Activation of CD127+132− Recent Thymic Emigrants into Terminally Differentiated CD127−132+ T-Cells in HIV-1 Infection

“…Cord blood mononuclear cells (CBMC; n = 5) were isolated from healthy infants after uncomplicated births. Patients with primary HIV infection had confirmed recent HIV infection by documented seroconversion illness and incomplete western blot (ie ≤3bands), or negative HIV serology within the preceding 6 months [28]. Patients with chronic HIV infection had been infected with HIV for longer than six months.…”

Infection of CD127+(Interleukin-7 Receptor+) CD4+Cells and Overexpression of CTLA-4 Are Linked to Loss of Antigen-Specific CD4 T Cells during Primary Human Immunodeficiency Virus Type 1 Infection

“…Cryopreserved PBMCs from three PHAEDRA/CORE 01 subjects and a further three subjects, who had been included in a previous study (68), at presentation of PHI were used in cell sorting experiments. These PBMCs were obtained a median of 8 days after the onset of symptoms.…”