Virologic failure is uncommon after treatment initiation during acute HIV infection

Crowell, Trevor A; Phanuphak, Nittaya; Pinyakorn, Suteeraporn; Kroon, Eugène; Fletcher, James; Colby, Donn; Tipsuk, Somporn; Karnsomlap, Putthachard; Laopraynak, Naphassanant; O’Connell, Robert J.; Robb, Merlin L.; Ananworanich, Jintanat

doi:10.1097/qad.0000000000001148

Cited by 27 publications

(28 citation statements)

References 24 publications

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“…As in other studies [25‐27], ART initiation during AHI rapidly led to high rates of viral suppression and near 90% of participants were virally suppressed by 12 months. Subsequent viral rebound while on ART was uncommon and time to viral rebound was similar between men and women.…”

Section: Discussionsupporting

confidence: 64%

Enhanced immunovirological response in women compared to men after antiretroviral therapy initiation during acute and early HIV‐1 infection: results from a longitudinal study in the French ANRS Primo cohort

et al. 2020

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Introduction: Previous studies have reported better immunovirological characteristics in women compared with men after HIV seroconversion. We investigated whether differences persisted under long-term antiretroviral therapy (ART) in individuals treated since acute and early HIV-1 infection (AHI). Methods: Data were obtained for 262 women and 1783 men enrolled between 1996 and 2017 in the French multicentre ANRS PRIMO cohort. We modelled the viral response, long-term immune recovery and HIV DNA decay in the 143 women and 1126 men who initiated ART within the first three months of infection. Results: The participants were mostly white. The mean age was 37 years at AHI diagnosis. Pre-ART viral loads were lower in women than men, 5.2 and 5.6 log 10 copies/mL (p = 0.001). After ART initiation, women more rapidly achieved viral suppression than men (adjusted hazard ratio: 1.33, 95% confidence interval 1.09 to 1.69). They also experienced a faster increase in CD4 + T-cell count and CD4:CD8 ratio during the first months of treatment. Sex-related differences in CD4 + T-cell counts were more pronounced with increasing age. This led to a sustained mean difference of 99 to 168 CD4 + T-cells/µL depending on age between women and men at 150 months of ART. Moreover, CD4:CD8 ratio of women was higher than that of men by 0.31, at 150 months of ART. There was no statistically significant difference between sexes for the levels of HIV DNA over time (mean estimate at the last modelling point: 1.9 log 10 copies/10 6 PBMCs after 70 months of ART for both sexes). Conclusions: The high level of immune recovery and decrease in total HIV DNA levels achieved after ART initiation during AHI reinforce the importance of early diagnosis of HIV infection and immediate ART initiation. The immunological benefit of being female increased throughout prolonged ART duration, which may give women additional protection from adverse clinical events and premature ageing.

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Section: Discussionsupporting

confidence: 64%

Enhanced immunovirological response in women compared to men after antiretroviral therapy initiation during acute and early HIV‐1 infection: results from a longitudinal study in the French ANRS Primo cohort

et al. 2020

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“…Same-day ART initiation for persons with AHI, in line with current Treat All initiatives, results in more rapid viral suppression compared to nonsame day initiation [188]. ART in AHI is highly effective and viral failure is uncommon [189]. While virological response for persons with chronic infection is characterized by suppression 6 months after ART initiation, the most effective means of reducing transmission during AHI requires regimens that rapidly reduce viral burden in genital fluids.…”

Section: Unique Challenges and Opportunities In Treating Ahimentioning

confidence: 97%

Clinical and public health implications of acute and early HIV detection and treatment: a scoping review

Rutstein

Ananworanich

Fidler

et al. 2017

Journal of the International AIDS Society

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116

140

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Introduction: The unchanged global HIV incidence may be related to ignoring acute HIV infection (AHI). This scoping review examines diagnostic, clinical, and public health implications of identifying and treating persons with AHI.Methods: We searched PubMed, in addition to hand-review of key journals identifying research pertaining to AHI detection and treatment. We focused on the relative contribution of AHI to transmission and the diagnostic, clinical, and public health implications. We prioritized research from low- and middle-income countries (LMICs) published in the last fifteen years.Results and Discussion: Extensive AHI research and limited routine AHI detection and treatment have begun in LMIC. Diagnostic challenges include ease-of-use, suitability for application and distribution in LMIC, and throughput for high-volume testing. Risk score algorithms have been used in LMIC to screen for AHI among individuals with behavioural and clinical characteristics more often associated with AHI. However, algorithms have not been implemented outside research settings. From a clinical perspective, there are substantial immunological and virological benefits to identifying and treating persons with AHI – evading the irreversible damage to host immune systems and seeding of viral reservoirs that occurs during untreated acute infection. The therapeutic benefits require rapid initiation of antiretrovirals, a logistical challenge in the absence of point-of-care testing. From a public health perspective, AHI diagnosis and treatment is critical to: decrease transmission via viral load reduction and behavioural interventions; improve pre-exposure prophylaxis outcomes by avoiding treatment initiation for HIV-seronegative persons with AHI; and, enhance partner services via notification for persons recently exposed or likely transmitting.Conclusions: There are undeniable clinical and public health benefits to AHI detection and treatment, but also substantial diagnostic and logistical barriers to implementation and scale-up. Effective early ART initiation may be critical for HIV eradication efforts, but widespread use in LMIC requires simple and accurate diagnostic tools. Implementation research is critical to facilitate sustainable integration of AHI detection and treatment into existing health systems and will be essential for prospective evaluation of testing algorithms, point-of-care diagnostics, and efficacious and effective first-line regimens.

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“…Virologic suppression should occur within 24 weeks of ART initiation even when initiated during acute infection. 112 Failure to achieve suppression by 24 weeks should prompt evaluation for virologic failure. After suppression is achieved, HIV RNA should be monitored every 3 months until suppression has been sustained for 1 year and at least every 6 months thereafter for adherent patients who remain clinically stable (evidence rating AIII).…”

Section: Laboratory Monitoringmentioning

confidence: 99%

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults

Günthard

Saag

Benson

et al. 2016

JAMA

555

313

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Virologic failure is uncommon after treatment initiation during acute HIV infection

Abstract: Virologic failure is uncommon in individuals who initiate ART during AHI. ART initiation during AHI is efficacious and clinicians can monitor for virologic failure after 24 weeks of therapy.

Cited by 27 publications

References 24 publications

Enhanced immunovirological response in women compared to men after antiretroviral therapy initiation during acute and early HIV‐1 infection: results from a longitudinal study in the French ANRS Primo cohort

Enhanced immunovirological response in women compared to men after antiretroviral therapy initiation during acute and early HIV‐1 infection: results from a longitudinal study in the French ANRS Primo cohort

Clinical and public health implications of acute and early HIV detection and treatment: a scoping review

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults

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