title: Virologic failure is uncommon after treatment initiation during acute HIV infection.
abstract: In chronic HIV infection, initiation of antiretroviral therapy (ART) typically induces swift HIV RNA declines and virologic suppression within 24 weeks. The objective of this study was to investigate viral dynamics and common criteria for treatment success after ART initiation during acute HIV infection (AHI).
  
  
  
  Participants were prospectively enrolled and offered ART during AHI from May 2009-June 2015 in Bangkok, Thailand. Regimens included tenofovir, lamivudine or emtricitabine, and efavirenz with or without raltegravir and maraviroc. Participants were monitored for several HIV RNA end points: one-log reduction at week 2; two-log reduction at week 4; less than 1000 copies/ml at week 24; and less than 200 copies/ml at week 24. Factors associated with each end point, time to suppression, and virologic blips were explored.
  
  
  
  Two hundred and sixty-four Thai participants initiated ART during AHI. Their median age was 27 years and 96% were men. At 2 weeks, 6.5% had not achieved a one-log reduction in HIV RNA. At 4 weeks, 11.0% had not achieved a two-log reduction. At 24 weeks, 1.1% had not achieved HIV RNA less than 1000 copies/ml and 1.5% had not achieved HIV RNA less than 200 copies/ml. Participants who initiated ART during Fiebig I demonstrated a shorter median time to virologic suppression than did all other stages combined, [4 (interquartile range 2-8) vs. 8 (interquartile range 4-12) weeks, P < 0.001] and 7.3% had subsequent blips (16.1% in other stages, P = 0.23).
  
  
  
  Virologic failure is uncommon in individuals who initiate ART during AHI. ART initiation during AHI is efficacious and clinicians can monitor for virologic failure after 24 weeks of therapy.
authors.affiliation: aU.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring bHenry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA cSEARCH dHIV-NAT, Thai Red Cross AIDS Research Centre eArmed Forces Research Institute of Medical Sciences, Bangkok, Thailand.
authors.forename: Trevor A
authors.initials: TA
authors.lastname: Crowell
authors.forename: Nittaya
authors.initials: N
authors.lastname: Phanuphak
authors.forename: Suteeraporn
authors.initials: S
authors.lastname: Pinyakorn
authors.forename: Eugene
authors.initials: E
authors.lastname: Kroon
authors.forename: James L K
authors.initials: JL
authors.lastname: Fletcher
authors.forename: Donn
authors.initials: D
authors.lastname: Colby
authors.forename: Somporn
authors.initials: S
authors.lastname: Tipsuk
authors.forename: Putthachard
authors.initials: P
authors.lastname: Karnsomlap
authors.forename: Naphassanant
authors.initials: N
authors.lastname: Laopraynak
authors.forename: Robert J
authors.initials: RJ
authors.lastname: O'Connell
authors.forename: Merlin L
authors.initials: ML
authors.lastname: Robb
authors.forename: Jintanat
authors.initials: J
authors.lastname: Ananworanich
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000072230:Sustained Virologic Response; D013785:Thailand; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents