title: Early antiretroviral therapy during primary HIV-1 infection results in a transient reduction of the viral setpoint upon treatment interruption.
abstract: BACKGROUND
  Long-term benefits of combination antiretroviral therapy (cART) initiation during primary HIV-1 infection are debated.
  
  
  METHODS
  The evolution of plasma HIV-RNA (432 measurements) and cell-associated HIV-DNA (325 measurements) after cessation of cART (median exposure 18 months) was described for 33 participants from the Zurich Primary HIV Infection Study using linear regression and compared with 545 measurements from 79 untreated controls with clinically diagnosed primary HIV infection, respectively a known date for seroconversion.
  
  
  RESULTS
  On average, early treated individuals were followed for 37 months (median) after cART cessation; controls had 34 months of pre-cART follow-up. HIV-RNA levels one year after cART interruption were -0.8 log₁₀ copies/mL [95% confidence interval -1.2;-0.4] lower in early treated patients compared with controls, but this difference was no longer statistically significant by year three of follow-up (-0.3 [-0.9; 0.3]). Mean HIV-DNA levels rebounded from 2 log₁₀ copies [1.8; 2.3] on cART to a stable plateau of 2.7 log₁₀ copies [2.5; 3.0] attained 1 year after therapy stop, which was not significantly different from cross-sectional measurements of 9 untreated members of the control group (2.8 log₁₀ copies [2.5; 3.1]).
  
  
  CONCLUSIONS
  The rebound dynamics of viral markers after therapy cessation suggest that early cART may indeed limit reservoir size of latently infected cells, but that much of the initial benefits are only transient. Owing to the non-randomized study design the observed treatment effects must be interpreted with caution.
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich, University of Zürich, Zürich, Switzerland.
authors.forename: Viktor von
authors.initials: Vv
authors.lastname: Wyl
authors.forename: Sara
authors.initials: S
authors.lastname: Gianella
authors.forename: Marek
authors.initials: M
authors.lastname: Fischer
authors.forename: Barbara
authors.initials: B
authors.lastname: Niederoest
authors.forename: Herbert
authors.initials: H
authors.lastname: Kuster
authors.forename: Manuel
authors.initials: M
authors.lastname: Battegay
authors.forename: Enos
authors.initials: E
authors.lastname: Bernasconi
authors.forename: Matthias
authors.initials: M
authors.lastname: Cavassini
authors.forename: Andri
authors.initials: A
authors.lastname: Rauch
authors.forename: Bernard
authors.initials: B
authors.lastname: Hirschel
authors.forename: Pietro
authors.initials: P
authors.lastname: Vernazza
authors.forename: Rainer
authors.initials: R
authors.lastname: Weber
authors.forename: Beda
authors.initials: B
authors.lastname: Joos
authors.forename: Huldrych F
authors.initials: HF
authors.lastname: Günthard
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D015415:Biomarkers / Q000097:blood*; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004279:DNA, Viral / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D006679:HIV Seropositivity; D015497:HIV-1 / Q000235:genetics*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D012367:RNA, Viral / Q000097:blood; D019562:Viral Load
chemical_list: D015415:Biomarkers; D004279:DNA, Viral; D012367:RNA, Viral
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