Highly active antiretroviral therapy with or without mycophenolate mofetil in treatment-naive HIV-1 patients.
OBJECTIVE
To study the effect of mycophenolate mofetil (MMF) on the decay rate of plasma HIV-1 RNA and the latently infected cellular reservoir in treatment-naive patients starting antiretroviral therapy.


METHODS
: Randomized trial.


METHODS
A group of 19 HIV-1 infected patients (9 with a chronic and 10 with a primary infection) starting a triple antiretroviral drug regimen were randomized to a group with or without MMF. Plasma samples for HIV-1 RNA were taken and HLA-DR-CD4+ T cells were co-cultured for HIV-1 isolation. Slopes of plasma HIV-1 RNA and cellular viral load decay were calculated for the first 14 days and the first 24 weeks of treatment, respectively.


RESULTS
The median plasma HIV-1 RNA daily decay rate in chronically infected patients was 0.25 log10 copies/ml [interquartile range (IQR), 0.18-0.30] with MMF and 0.28 log10 copies/ml (IQR, 0.22-0.32) without MMF (P = 0.56); in primary infected patients, it was 0.31 log10 copies/ml (IQR, 0.31-0.32) with MMF and 0.32 log10 copies/ml (IQR, 0.26-0.34) without MMF (P = 0.75). The median daily decay rate of latently infected cells was 0.017 and 0.004 infected cells/10 cells in patients with and without MMF, respectively (P = 0.89). The increase in CD4 T cells was comparable between patients with and without MMF. After stopping MMF, there was an increase in the cellular reservoir in six of eight patients.


CONCLUSIONS
The addition of MMF to a triple class antiretroviral regimen in treatment-naive patients does not significantly increase the plasma HIV-1 RNA decay rate or the decay rate of the latently infected cellular reservoir.
Sankatsing
Sanjay U C
SU
Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, University of Amsterdam, The Netherlands.
Jurriaans
Suzanne
S
van Swieten
Peter
P
van Leth
Frank
F
Cornelissen
Marion
M
Miedema
Frank
F
Lange
Joep M A
JM
Schuitemaker
Hanneke
H
Prins
Jan M
JM
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D012367:RNA, Viral / Q000097:blood
D004791:Enzyme Inhibitors; D012367:RNA, Viral; D009173:Mycophenolic Acid