title: The impact of transient combination antiretroviral treatment in early HIV infection on viral suppression and immunologic response in later treatment.
abstract: OBJECTIVE
  Effects of transient combination antiretroviral treatment (cART) initiated during early HIV infection (EHI) remain unclear. We investigate whether this intervention affects viral suppression and CD4 cell count increase following its reinitiation in chronic infection (CHI).
  
  
  METHODS
  Longitudinal observational study.
  
  
  METHODS
  We identified adult patients from Concerted Action of Seroconversion to AIDS and Death in Europe who seroconverted after 1/1/2000, had a 12 months or less HIV test interval and initiated cART from naive. We classified individuals as 'pretreated in EHI' if treated within 6 months of seroconversion, interrupted for at least 12 weeks, and reinitiated during CHI. Statistical analysis was performed using survival analysis methods and mixed models.
  
  
  RESULTS
  Pretreated and initiated in CHI groups comprised 202 and 4263 individuals, with median follow-up after CHI treatment 4.5 and 3 years, respectively. Both groups had similar virologic response and relapse rates (P = 0.585 and P = 0.206) but pretreated individuals restarted treatment with higher baseline CD4 cell count (∼80 cells/μl; P < 0.001) and retained significantly higher CD4 cell count for more than 3 years after treatment (re)initiation. Assuming common baseline CD4 cell count, differences in CD4 cell count slopes were nonsignificant. Immunovirologic response to CHI treatment was not associated with timing or duration of the transient treatment.
  
  
  CONCLUSIONS
  Although treatment interruptions are not recommended, stopping cART initiated in EHI does not seem to reduce the chance of a successful outcome of treatment in CHI.
authors.affiliation: aDepartment of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, GreecebFaculte de Medecine Paris SudcINSERM U1018, Centre de recherche en Epidemiologie et Sante des Populations, Universite Paris Sud, Le Kremlin Bicetre, FrancedMedical Research Council Clinical Trials Unit, University College London, London, UKeINSERMfSorbonne Universités, UPMC Univ Paris 06, UMRS 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, FrancegKirby Institute, UNSW, Sydney, AustraliahDepartment of Microbiology, Faculty of Medicine, University of Tartu, Tartu, EstoniaiLaboratoire de Virologie, Hopital Saint Louis, Universite Paris Diderot, INSERM U941, Paris, FrancejHIV/GUM Research, Brighton and Sussex University Hospitals NHS Trust, Brighton and Sussex Medical School, Brighton, UKkInfectious Diseases Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain.
authors.forename: Nikos
authors.initials: N
authors.lastname: Pantazis
authors.forename: Giota
authors.initials: G
authors.lastname: Touloumi
authors.forename: Laurence
authors.initials: L
authors.lastname: Meyer
authors.forename: Ashley
authors.initials: A
authors.lastname: Olson
authors.forename: Dominique
authors.initials: D
authors.lastname: Costagliola
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Kelleher
authors.forename: Irja
authors.initials: I
authors.lastname: Lutsar
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Chaix
authors.forename: Martin
authors.initials: M
authors.lastname: Fisher
authors.forename: Santiago
authors.initials: S
authors.lastname: Moreno
authors.forename: Kholoud
authors.initials: K
authors.lastname: Porter
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D018791:CD4 Lymphocyte Count; D005060:Europe; D005260:Female; D006678:HIV / Q000276:immunology* / Q000302:isolation & purification*; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D019562:Viral Load; D028761:Withholding Treatment; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents