Kaiser highlights recently published Journal of Infectious Diseases studies

The following summarizes studies recently published in the Journal of Infectious Diseases.

• "A Multicenter Observational Study of the Potential Benefits of Initiating Combination Antiretroviral Therapy During Acute HIV Infection": Frederick Hecht of the University of California-San Francisco and colleagues examined whether initiating highly active antiretroviral therapy within two weeks of HIV seroconversion -- known as acute treatment -- or between two weeks and six months after seroconversion -- known as early treatment -- leads to a longer-term decrease in viral load and an increase in CD4+ T cell counts after treatment is discontinued. Researchers enrolled participants from the Acute Infection and Early Disease Research Program within six months of HIV seroconversion. Thirteen participants self-selected to initiate acute HAART treatment, 45 self-selected early HAART treatment and 337 declined treatment. Participants who chose to receive HAART did so for at least 12 weeks and subsequently ceased treatment. The researchers compared viral loads and CD4+ T cell counts in the three groups at 24, 48 and 72 weeks after they ceased treatment. The study finds that the acute treatment group had lower average viral loads 24 weeks after ending HAART and a higher average CD4+ T cell count, compared with the untreated group. The early treatment group also had lower viral loads at 24 weeks than the untreated group. However, by week 48 there was no significant difference in viral loads between the early treatment group and the untreated group. According to the researchers, initiating HAART within two weeks of seroconversion can be beneficial in reducing viral load and increasing CD4+ T cell counts for 24 weeks after treatment termination, and "trends toward a longer-term benefit" were observed. In addition, later initiation of HAART contributed to a "continuing but decreasing CD4+ T cell count benefit and a loss of the viral load benefit by week 72 after discontinuation of treatment," the study says (Hecht et al., Journal of Infectious Diseases, 8/15).

• "Immunological and Virlogical Impact of Highly Active Antiretroviral Therapy Initiated During Acute HIV-1 Infection": Hendrick Streeck of the Partners AIDS Research Center in Boston and colleagues between October 2002 and November 2003 enrolled in the study 20 men who have sex with men in Berlin who recently had contracted HIV-1. The participants were given a choice to begin highly active antiretroviral therapy for 24 weeks or to be monitored closely without receiving antiretroviral therapy. Twelve of the MSM began HAART at an estimated median of 25 days after becoming HIV-positive. The study finds that the HIV-positive people receiving HAART after 24 weeks had suppressed viral loads and increased CD4+ T cell counts but that there was no difference between the two groups' viral loads and CD4+ T cell counts six months after HAART was stopped. The study says that "short-term HAART initiated during acute HIV-1 infection has no major impact" on controlling viral loads (Streeck et al., Journal of Infectious Diseases, 8/15). Sabine Kinloch-de Loes of the Royal Free University College Medical School's Centre for HIV Medicine in a related commentary writes that because the "optimal time" to initiate antiretroviral therapy for HIV-positive people "remains unknown, ... there is a strong case for testing interventions early after infection" and that further study is needed (Kinloch-de Loes, Journal of Infectious Diseases, 8/15).