An observational study on patients treated or not for acute HIV infection.
BACKGROUND
A vast majority of HIV-infected subjects who experience HIV acute seroconversion actually receive treatment. Open questions are how can we identify patients who will be slow progressors or long-term non progressors, and, as a consequence, do not require treatment.


METHODS
An observational retrospective study on patients who experienced acute HIV seroconversion from August 1995 to June 2001, who are still alive and followed as outpatients at the Clinic of Infectious Diseases of Modena, Italy.


RESULTS
Twelve patients were studied. Five patients (45.4%) were treated during acute seroconversion, while 7 were not treated. Two of these seven subjects received antiretroviral treatment 12 and 26 weeks after acute seroconversion. All the untreated patients were in good viro-immunological condition 6 months after seroconversion, and 2 of them also after 3 and 7 years. Patients who were treated showed a significant daily increase in CD4/CD8 T cell ratio with longer time spent on therapy (0.04% increase per day longer on antiretroviral therapy, p=0.02).


CONCLUSIONS
This study suggests that treatment during primary HIV infection should not be considered in all patients. Randomized clinical trials enrolling patients with an asymptomatic primary HIV infection, with a high CD4 count and low HIV plasma viremia are needed to evaluate the indications for treatment in this subgroup of patients. On the other hand, this study confirms the good viro-immunological response obtained after treating patients during primary HIV infection.
Mussini
C
C
Clinic of Infectious Diseases, Policlinico and University of Modena and Reggio Emilia, Italy. crimuss@unimo.it
Cozzi-Lepri
A
A
Bedini
A
A
Borghi
V
V
Mongiardo
N
N
Cossarizza
A
A
Esposito
R
R
D000208:Acute Disease; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D016516:CD4-CD8 Ratio; D004279:DNA, Viral / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D016655:HIV Core Protein p24 / Q000097:blood; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D020276:HIV Long-Term Survivors; D006679:HIV Seropositivity / Q000188:drug therapy / Q000453:epidemiology; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D012307:Risk Factors; D019562:Viral Load; D014766:Viremia / Q000188:drug therapy / Q000453:epidemiology
D019380:Anti-HIV Agents; D004279:DNA, Viral; D016655:HIV Core Protein p24; D012367:RNA, Viral