Dynamics of the pool of infected resting CD4 HLA-DR- T lymphocytes in patients who started a triple class five-drug antiretroviral regimen during primary HIV-1 infection.
Starting standard antiretroviral therapy within 10 days after the onset of a primary HIV-1 infection cannot prevent the establishment of a reservoir of HIV-1-infected memory CD4 T cells. Here we studied the reservoir of HIV-1-infected memory CD4 T cells in four patients who started a triple class, five-drug regimen during primary HIV-1 infection. There was a strong correlation between the proportion of productively infected CD4 HLA-DR- T lymphocytes and plasma HIV-1 RNA levels (r=0.852; P<0.001) during the first 24 weeks of therapy. Within 45 weeks of treatment, in three of the four patients the proportion of productively infected CD4 HLA-DR- T lymphocytes was reduced below the level of quantification. In the fourth patient the cellular reservoir remained quantifiable. In two patients who stopped therapy 44 weeks after initiation an immediate rebound of the plasma HIV-1 RNA level and the proportion of productively infected CD4 HLA-DR- T lymphocytes occurred. In conclusion, initiation of a potent five-drug, triple class regimen during primary HIV-1 infection does not result in virus-specific immune control upon discontinuation of therapy after 44 weeks. Therefore, longer or even stronger suppression of viral replication might be necessary to achieve this goal in primary HIV-1 infection.
National AIDS Therapy Evaluation Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. s.u.sankatsing@amc.uva.nl
Sanjay U C
SU
Sankatsing
Rieneke M E
RM
van Praag
Ronald P
RP
van Rij
Ronald
R
Rientsma
Suzanne
S
Jurriaans
Joep M A
JM
Lange
Jan M
JM
Prins
Hanneke
H
Schuitemaker
D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000821:virology*; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000276:immunology*; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification; D006684:HLA-DR Antigens / Q000032:analysis*; D006801:Humans; D012367:RNA, Viral / Q000097:blood; D014779:Virus Replication / Q000187:drug effects
D019380:Anti-HIV Agents; D006684:HLA-DR Antigens; D012367:RNA, Viral