Impact of very early antiretroviral therapy during acute HIV infection on long-term immunovirological outcomes

Objectives: We aimed to determine if starting antiretroviral therapy (ART) in the first 30 days after acquiring HIV infection has an impact on immunovirological response. Methods: Observational, ambispective study including 147 patients with confirmed acute HIV infection (January/1995-August/2022)....

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Detalles Bibliográficos
Autores: Suanzes, Paula|||0000-0002-6871-0098, Navarro, Jordi|||0000-0002-7187-0367, Rando-Segura, Ariadna|||0000-0003-4555-7286, Álvarez-López, Patricia|||0000-0003-4227-1987, García Pérez, Jorge N.|||0000-0003-4986-6094, Descalzo Jorro, Vicente, Monforte-Pallarés, Arnau|||0000-0002-5468-3885, Arando, Maider|||0000-0003-2020-4193, Rodríguez Vázquez, Lucía|||0000-0003-0151-3142, Planas, Bibiana|||0000-0002-1490-7127, Burgos, Joaquín|||0000-0001-8445-3047, Curran, Adrian|||0000-0002-1263-0814, Buzón, Maria José|||0000-0003-4427-9413, Falcó, Vicenç|||0000-0001-9626-0023
Tipo de recurso: artículo
Fecha de publicación:2023
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:dnet:uabarcelona_::38742ae9df676a68e2ca865d6b9b64c6
Acceso en línea:https://ddd.uab.cat/record/328149
https://dx.doi.org/urn:doi:10.1016/j.ijid.2023.09.009
Access Level:acceso abierto
Palabra clave:HIV infection
Acute HIV infection
Immune recovery
CD4+/CD8+ ratio
Antiretroviral treatment
Early treatment
Descripción
Sumario:Objectives: We aimed to determine if starting antiretroviral therapy (ART) in the first 30 days after acquiring HIV infection has an impact on immunovirological response. Methods: Observational, ambispective study including 147 patients with confirmed acute HIV infection (January/1995-August/2022). ART was defined as very early (≤30 days after the estimated date of infection), early (31-180 days), and late (>180 days). We compared time to viral suppression (viral load [VL] <50 copies/ml) and immune recovery (IR) (CD4+/CD8+ ratio ≥1) according to the timing and type of ART using survival analysis. Results: ART was started in 140 (95.2%) patients. ART was very early in 24 (17.1%), early in 77 (55.0%), and late in 39 (27.9%) cases. Integrase strand transfer inhibitor (INSTI)-based regimens were the most used in both the overall population (65%) and the very early ART group (23/24, 95.8%). Median HIV VL and CD4+/CD8+ ratio pre-ART were higher in the very early ART group (P <0.05). Patients in the very early and early ART groups and treated with INSTI-based regimens achieved IR earlier (P <0.05). Factors associated with faster IR were the CD4+/CD8+ ratio pre-ART (hazard ratio: 9.3, 95% CI: 3.1-27.8, P <0.001) and INSTI-based regimens (hazard ratio: 2.4, 95% CI: 1.3-4.2, P = 0.003). Conclusions: The strongest predictors of IR in patients who start ART during AHI are the CD4+/CD8+ ratio pre-ART and INSTI-based ART regimens.

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