title: Does transient cART started during primary HIV infection undermine the long-term immunologic and virologic response on cART resumption?
abstract: BACKGROUND
  We explored the impact of transient cART started during the primary HIV-infection (PHI) on the long-term immunologic and virologic response on cART resumption, by comparison with treatment initiation during the chronic phase of HIV infection (CHI).
  
  
  METHODS
  We analyzed data on 1450 patients enrolled during PHI in the ANRS PRIMO cohort between 1996 and 2013. "Treatment resumption" was defined as at least 3 months of resumed treatment following interruption of at least 1 month of treatment initiated during PHI. "Treatment initiation during CHI" was defined as cART initiated ≥6 months after PHI. The virologic response to resumed treatment and to treatment initiated during CHI was analyzed with survival models. The CD4 cell count dynamics was modeled with piecewise linear mixed models.
  
  
  RESULTS
  136 patients who resumed cART for a median (IQR) of 32 (18-51) months were compared with 377 patients who started cART during CHI for a median of 45 (22-57) months. Most patients (97%) achieved HIV-RNA <50 cp/mL after similar times in the two groups. The CD4 cell count rose similarly in the two groups during the first 12 months. However, after 12 months, patients who started cART during CHI had a better immunological response than those who resumed cART (p = 0.01); therefore, at 36 months, the gains in √CD4 cells/mm(3) and CD4% were significantly greater in patients who started treatment during CHI.
  
  
  CONCLUSIONS
  These results suggest that interruption of cART started during PHI has a significant, albeit modest negative impact on CD4 cell recovery on cART resumption.
authors.affiliation: INSERM, U1018, Epidemiology of HIV and STI, CESP; University Paris-Sud, Le Kremlin-Bicêtre, France. krastinova@gmail.com.|Department of Public Health and Epidemiology, Bicêtre Hospital, AP-HP, Le Kremlin Bicêtre, France. krastinova@gmail.com.
authors.forename: Evguenia
authors.initials: E
authors.lastname: Krastinova
authors.affiliation: INSERM, U1018, Epidemiology of HIV and STI, CESP; University Paris-Sud, Le Kremlin-Bicêtre, France. remonie.seng@inserm.fr.|Department of Public Health and Epidemiology, Bicêtre Hospital, AP-HP, Le Kremlin Bicêtre, France. remonie.seng@inserm.fr.
authors.forename: Remonie
authors.initials: R
authors.lastname: Seng
authors.affiliation: INSERM, U1018, Epidemiology of HIV and STI, CESP; University Paris-Sud, Le Kremlin-Bicêtre, France. jerome.lechenadec@inserm.fr.
authors.forename: Jerome
authors.initials: J
authors.lastname: Lechenadec
authors.affiliation: INSERM, U1018, Gender, Sexual and Reproductive Health, Le Kremlin-Bicêtre, France. henri.panjo@inserm.fr.
authors.forename: Henri
authors.initials: H
authors.lastname: Panjo
authors.affiliation: INSERM, U1018, Epidemiology of HIV and STI, CESP; University Paris-Sud, Le Kremlin-Bicêtre, France. asma.essat@inserm.fr.
authors.forename: Asma
authors.initials: A
authors.lastname: Essat
authors.affiliation: Department of Infectious and Tropical Disease, Edouard Herriot Hospital, Lyon, France. djamila.makhloufi@chu-lyon.fr.
authors.forename: Djamila
authors.initials: D
authors.lastname: Makhloufi
authors.affiliation: Department of Infectious and Tropical Disease, Purpan Hospital, Toulouse, France. obadia.m@chu-toulouse.fr.
authors.forename: Martine
authors.initials: M
authors.lastname: Obadia
authors.affiliation: Department of Infectious and Tropical Disease, Bretonneau Hospital, Tours, France. l.bernard@chu-tours.fr.
authors.forename: Louis
authors.initials: L
authors.lastname: Bernard
authors.affiliation: INSERM, U1018, Epidemiology of HIV and STI, CESP; University Paris-Sud, Le Kremlin-Bicêtre, France. cecile.goujard@bct.aphp.fr.|Department of Internal Medicine, Bicêtre Hospital, AP-HP; University Paris-Sud, Le Kremlin-Bicêtre, France. cecile.goujard@bct.aphp.fr.
authors.forename: Cecile
authors.initials: C
authors.lastname: Goujard
authors.affiliation: INSERM, U1018, Epidemiology of HIV and STI, CESP; University Paris-Sud, Le Kremlin-Bicêtre, France. laurence.meyer@inserm.fr.|Department of Public Health and Epidemiology, Bicêtre Hospital, AP-HP, Le Kremlin Bicêtre, France. laurence.meyer@inserm.fr.
authors.forename: Laurence
authors.initials: L
authors.lastname: Meyer
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000166:cytology / Q000276:immunology; D015331:Cohort Studies; D005260:Female; D006678:HIV / Q000235:genetics*; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000032:analysis
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral