title: Virological and immunological effects of short-course antiretroviral therapy in primary HIV infection.
abstract: BACKGROUND
  National and international guidelines call for the treatment of primary HIV infection (PHI) with combination antiretroviral therapy, although the ideal timing and duration of this intervention is unknown. Recent immunological studies of antiretroviral therapy on small numbers of patients with PHI have reported preservation of HIV-specific CD4 T-helper responses, ordinarily lost in the absence of intervention. We sought to investigate whether a short course of antiretroviral therapy (SCART) at PHI was sufficient to preserve HIV-specific cellular immunity.
  
  
  METHODS
  Forty-five subjects with confirmed PHI were offered SCART at diagnosis. HIV specific cellular immune responses and virological parameters were assessed at monthly intervals.
  
  
  RESULTS
  Thirty-seven of the subjects chose SCART at PHI, and achieved a plasma viral load < 50 RNA copies/ml by a median of 10 weeks (range, 4-32 weeks). Two of the 45 individuals had evidence of genotypic HIV drug resistance at baseline, and none developed new mutations following therapy. All patients who received SCART at PHI showed preservation of HIV-specific CD4 T-helper responses up to 64 weeks off SCART.
  
  
  CONCLUSIONS
  SCART at PHI was safe, did not induce the development of drug resistance, and appeared sufficient to preserve HIV-specific CD4 T-helper responses. However, PHI is highly heterogeneous, and a large-scale randomized trial of SCART at PHI is now needed.
authors.affiliation: Wright Fleming Institute, Department of GUM and Communicable Diseases, Faculty of Medicine, Imperial College, St Mary's Hospital, London, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Fidler
authors.forename: Annette
authors.initials: A
authors.lastname: Oxenius
authors.forename: Michael
authors.initials: M
authors.lastname: Brady
authors.forename: John
authors.initials: J
authors.lastname: Clarke
authors.forename: Ian
authors.initials: I
authors.lastname: Cropley
authors.forename: Abdel
authors.initials: A
authors.lastname: Babiker
authors.forename: Hua-Tang
authors.initials: HT
authors.lastname: Zhang
authors.forename: David
authors.initials: D
authors.lastname: Price
authors.forename: Rodney
authors.initials: R
authors.lastname: Phillips
authors.forename: Jonathan
authors.initials: J
authors.lastname: Weber
mesh_terms: D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D015497:HIV-1 / Q000276:immunology / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors