title: Rapid plasma viral suppression in naive HIV-infected patients with high CD4 cells and low viraemia initiating a dual nucleoside reverse transcriptase inhibitor strategy: a proof-of-concept study.
abstract: OBJECTIVE
  To evaluate whether a dual nucleoside reverse transcriptase inhibitor (NRTI) strategy can control HIV replication in antiviral therapy (ART)-naive HIV-infected patients with a high CD4 cell count and a low viral load (VL).
  
  
  METHODS
  This observational study included all HIV-infected treatment-naive patients with a CD4 cell count >300 cells/mm(3), a plasma HIV RNA between 1000 copies/mL and 30,000 copies/mL and wild-type virus who initiated dual NRTI ART between January 2008 and December 2012. HIV RNA and CD4 cell count were assessed at Day 0, Week (W) 4, W12, W24 and W48. The primary endpoint was the proportion of patients with a plasma VL (pVL) <50 copies/mL at W24.
  
  
  RESULTS
  Twenty patients were included. The median (IQR) baseline characteristics were: time since HIV diagnosis, 25 months (8-66 months); CD4 cell count, 592 cells/mm(3) (405-798 cells/mm(3)); HIV RNA, 10,395 copies/mL (4106-16,566 copies/mL); and HIV DNA, 464 copies/10(6) peripheral blood mononuclear cells (195-1168 copies/10(6) PBMC). Nineteen patients received tenofovir/emtricitabine and one patient received abacavir/lamivudine. At W12, 88% of the patients with available data (n = 16/18, 95% CI 0.65-0.99) had a pVL <50 copies/mL. Overall, the proportion of patients with a pVL <50 copies/mL was 100% (n = 20/20, 95% CI 0.83-1.0) at W24 and 95% (n = 18/19, 95% CI 0.74-0.99) at W48 (with one patient lost to follow-up and one patient with poor treatment compliance). The median increase in CD4 cells was 83 cells/mm(3) (40-310 cells/mm(3)). There was no discontinuation of antiretroviral therapy for any reason such as lack of efficacy or toxicity.
  
  
  CONCLUSIONS
  This pilot study suggests that, in patients with a high CD4 cell count and a low VL, a dual NRTI strategy may represent a potentially effective treatment strategy to control HIV replication. This needs to be confirmed in larger controlled clinical studies.
authors: AP-HP, Department of Infectious Diseases, Pitié-Salpêtrière University Hospital, Paris, France Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institute Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France.
authors: S
authors: S
authors: Seang
authors: Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institute Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France AP-HP, Virology Department, Pitié Salpêtrière University Hospital, Paris, France.
authors: S
authors: S
authors: Fourati
authors: AP-HP, Department of Infectious Diseases, Pitié-Salpêtrière University Hospital, Paris, France Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institute Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France.
authors: Y
authors: Y
authors: Keita
authors: AP-HP, Department of Infectious Diseases, Pitié-Salpêtrière University Hospital, Paris, France Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institute Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France.
authors: C
authors: C
authors: Blanc
authors: AP-HP, Department of Infectious Diseases, Pitié-Salpêtrière University Hospital, Paris, France Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institute Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France.
authors: R
authors: R
authors: Tubiana
authors: AP-HP, Department of Infectious Diseases, Pitié-Salpêtrière University Hospital, Paris, France Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institute Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France.
authors: L
authors: L
authors: Schneider
authors: AP-HP, Department of Infectious Diseases, Pitié-Salpêtrière University Hospital, Paris, France Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institute Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France.
authors: M A
authors: MA
authors: Valantin
authors: AP-HP, Department of Infectious Diseases, Pitié-Salpêtrière University Hospital, Paris, France Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institute Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France.
authors: F
authors: F
authors: Caby
authors: AP-HP, Department of Infectious Diseases, Pitié-Salpêtrière University Hospital, Paris, France Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institute Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France.
authors: R
authors: R
authors: Calin
authors: Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institute Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France AP-HP, Virology Department, Pitié Salpêtrière University Hospital, Paris, France.
authors: S
authors: S
authors: Lambert-Niclot
authors: Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institute Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France AP-HP, Virology Department, Pitié Salpêtrière University Hospital, Paris, France.
authors: A-G
authors: AG
authors: Marcelin
authors: Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institute Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France AP-HP, Virology Department, Pitié Salpêtrière University Hospital, Paris, France.
authors: V
authors: V
authors: Calvez
authors: Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institute Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France.
authors: D
authors: D
authors: Costagliola
authors: AP-HP, Department of Infectious Diseases, Pitié-Salpêtrière University Hospital, Paris, France Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institute Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France christine.katlama@me.com.
authors: C
authors: C
authors: Katlama
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009705:Nucleosides / Q000627:therapeutic use*; D010949:Plasma / Q000821:virology; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D009705:Nucleosides; D018894:Reverse Transcriptase Inhibitors
keywords: NRTIs; antiretroviral therapy; antiviral