The impact of transient combination antiretroviral treatment in early HIV infection on viral suppression and immunologic response in later treatment
Identifieur interne : 001573 ( Main/Exploration ); précédent : 001572; suivant : 001574The impact of transient combination antiretroviral treatment in early HIV infection on viral suppression and immunologic response in later treatment
Auteurs : Nikos Pantazis [Grèce] ; Giota Touloumi [Grèce] ; Laurence Meyer [France] ; Ashley Olson [Royaume-Uni] ; Dominique Costagliola [France] ; Anthony D. Kelleher [Australie] ; Irja Lutsar [Estonie] ; Marie-Laure Chaix [France] ; Martin Fisher [Royaume-Uni] ; Santiago Moreno [Espagne] ; Kholoud Porter [Royaume-Uni]Source :
- AIDS (London, England) [ 0269-9370 ] ; 2016.
Abstract
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).
Longitudinal observational study.
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.
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 (
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.
Url:
DOI: 10.1097/QAD.0000000000000991
PubMed: 26636925
PubMed Central: 4794189
Affiliations:
- Australie, Espagne, Estonie, France, Grèce, Royaume-Uni
- Angleterre, Attique (région), Communauté de Madrid, Grand Londres, Nouvelle-Galles du Sud, Île-de-France
- Athènes, Londres, Madrid, Orsay, Paris, Sydney
- University College de Londres, Université Paris-Sud
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Kelleher</name><affiliation wicri:level="3"><nlm:aff id="aff7">Kirby Institute, UNSW, Sydney, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Kirby Institute, UNSW, Sydney</wicri:regionArea><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Lutsar, Irja" sort="Lutsar, Irja" uniqKey="Lutsar I" first="Irja" last="Lutsar">Irja Lutsar</name><affiliation wicri:level="1"><nlm:aff id="aff8">Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia</nlm:aff><country xml:lang="fr">Estonie</country><wicri:regionArea>Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu</wicri:regionArea><wicri:noRegion>Tartu</wicri:noRegion></affiliation></author><author><name sortKey="Chaix, Marie Laure" sort="Chaix, Marie Laure" uniqKey="Chaix M" first="Marie-Laure" last="Chaix">Marie-Laure Chaix</name><affiliation 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Brighton</wicri:regionArea><wicri:noRegion>Brighton</wicri:noRegion></affiliation></author><author><name sortKey="Moreno, Santiago" sort="Moreno, Santiago" uniqKey="Moreno S" first="Santiago" last="Moreno">Santiago Moreno</name><affiliation wicri:level="3"><nlm:aff id="aff11">Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Espagne</country><wicri:regionArea>Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Porter, Kholoud" sort="Porter, Kholoud" uniqKey="Porter K" first="Kholoud" last="Porter">Kholoud Porter</name><affiliation wicri:level="4"><nlm:aff id="aff4">Medical Research 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uniqKey="Pantazis N" first="Nikos" last="Pantazis">Nikos Pantazis</name><affiliation wicri:level="3"><nlm:aff id="aff1">Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece</nlm:aff><country xml:lang="fr">Grèce</country><wicri:regionArea>Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens</wicri:regionArea><placeName><settlement type="city">Athènes</settlement><region nuts="2" type="region">Attique (région)</region></placeName></affiliation></author><author><name sortKey="Touloumi, Giota" sort="Touloumi, Giota" uniqKey="Touloumi G" first="Giota" last="Touloumi">Giota Touloumi</name><affiliation wicri:level="3"><nlm:aff id="aff1">Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece</nlm:aff><country xml:lang="fr">Grèce</country><wicri:regionArea>Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens</wicri:regionArea><placeName><settlement type="city">Athènes</settlement><region nuts="2" type="region">Attique (région)</region></placeName></affiliation></author><author><name sortKey="Meyer, Laurence" sort="Meyer, Laurence" uniqKey="Meyer L" first="Laurence" last="Meyer">Laurence Meyer</name><affiliation><nlm:aff id="aff2">Faculte de Medecine Paris Sud</nlm:aff></affiliation><affiliation wicri:level="4"><nlm:aff id="aff3">INSERM U1018, Centre de recherche en Epidemiologie et Sante des Populations, Universite Paris Sud, Le Kremlin Bicetre, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>INSERM U1018, Centre de recherche en Epidemiologie et Sante des Populations, Universite Paris Sud, Le Kremlin Bicetre</wicri:regionArea><wicri:noRegion>Le Kremlin Bicetre</wicri:noRegion><orgName type="university">Université Paris-Sud</orgName><placeName><settlement type="city">Orsay</settlement><region type="region" nuts="2">Île-de-France</region></placeName></affiliation></author><author><name sortKey="Olson, Ashley" sort="Olson, Ashley" uniqKey="Olson A" first="Ashley" last="Olson">Ashley Olson</name><affiliation wicri:level="4"><nlm:aff id="aff4">Medical Research Council Clinical Trials Unit, University College London, London, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Medical Research Council Clinical Trials Unit, University College London, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region><settlement type="city">Londres</settlement></placeName><orgName type="university">University College de Londres</orgName></affiliation></author><author><name sortKey="Costagliola, Dominique" sort="Costagliola, Dominique" uniqKey="Costagliola D" first="Dominique" last="Costagliola">Dominique Costagliola</name><affiliation><nlm:aff id="aff5">INSERM</nlm:aff></affiliation><affiliation wicri:level="3"><nlm:aff id="aff6">Sorbonne Universités, UPMC Univ Paris 06, UMRS 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Sorbonne Universités, UPMC Univ Paris 06, UMRS 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Kelleher, Anthony D" sort="Kelleher, Anthony D" uniqKey="Kelleher A" first="Anthony D." last="Kelleher">Anthony D. Kelleher</name><affiliation wicri:level="3"><nlm:aff id="aff7">Kirby Institute, UNSW, Sydney, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Kirby Institute, UNSW, Sydney</wicri:regionArea><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Lutsar, Irja" sort="Lutsar, Irja" uniqKey="Lutsar I" first="Irja" last="Lutsar">Irja Lutsar</name><affiliation wicri:level="1"><nlm:aff id="aff8">Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia</nlm:aff><country xml:lang="fr">Estonie</country><wicri:regionArea>Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu</wicri:regionArea><wicri:noRegion>Tartu</wicri:noRegion></affiliation></author><author><name sortKey="Chaix, Marie Laure" sort="Chaix, Marie Laure" uniqKey="Chaix M" first="Marie-Laure" last="Chaix">Marie-Laure Chaix</name><affiliation wicri:level="3"><nlm:aff id="aff9">Laboratoire de Virologie, Hopital Saint Louis, Universite Paris Diderot, INSERM U941, Paris, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Laboratoire de Virologie, Hopital Saint Louis, Universite Paris Diderot, INSERM U941, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Fisher, Martin" sort="Fisher, Martin" uniqKey="Fisher M" first="Martin" last="Fisher">Martin Fisher</name><affiliation wicri:level="1"><nlm:aff id="aff10">HIV/GUM Research, Brighton and Sussex University Hospitals NHS Trust, Brighton and Sussex Medical School, Brighton, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>HIV/GUM Research, Brighton and Sussex University Hospitals NHS Trust, Brighton and Sussex Medical School, Brighton</wicri:regionArea><wicri:noRegion>Brighton</wicri:noRegion></affiliation></author><author><name sortKey="Moreno, Santiago" sort="Moreno, Santiago" uniqKey="Moreno S" first="Santiago" last="Moreno">Santiago Moreno</name><affiliation wicri:level="3"><nlm:aff id="aff11">Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Espagne</country><wicri:regionArea>Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Porter, Kholoud" sort="Porter, Kholoud" uniqKey="Porter K" first="Kholoud" last="Porter">Kholoud Porter</name><affiliation wicri:level="4"><nlm:aff id="aff4">Medical Research Council Clinical Trials Unit, University College London, London, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Medical Research Council Clinical Trials Unit, University College London, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region><settlement type="city">Londres</settlement></placeName><orgName type="university">University College de Londres</orgName></affiliation></author></analytic><series><title level="j">AIDS (London, England)</title><idno type="ISSN">0269-9370</idno><idno type="eISSN">1473-5571</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Objective:</title><p>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<sup>+</sup> cell count increase following its reinitiation in chronic infection (CHI).</p></sec><sec><title>Design:</title><p>Longitudinal observational study.</p></sec><sec sec-type="methods"><title>Methods:</title><p>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.</p></sec><sec sec-type="results"><title>Results:</title><p>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 (<italic>P</italic> = 0.585 and <italic>P</italic> = 0.206) but pretreated individuals restarted treatment with higher baseline CD4<sup>+</sup> cell count (∼80 cells/μl; <italic>P</italic> < 0.001) and retained significantly higher CD4<sup>+</sup> cell count for more than 3 years after treatment (re)initiation. Assuming common baseline CD4<sup>+</sup> cell count, differences in CD4<sup>+</sup> cell count slopes were nonsignificant. Immunovirologic response to CHI treatment was not associated with timing or duration of the transient treatment.</p></sec><sec sec-type="conclusion"><title>Conclusion:</title><p>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.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Lyles, Rh" uniqKey="Lyles R">RH Lyles</name></author><author><name sortKey="Munoz, A" uniqKey="Munoz A">A Munoz</name></author><author><name sortKey="Yamashita, Te" uniqKey="Yamashita T">TE Yamashita</name></author><author><name sortKey="Bazmi, H" uniqKey="Bazmi H">H Bazmi</name></author><author><name sortKey="Detels, R" uniqKey="Detels R">R Detels</name></author><author><name sortKey="Rinaldo, Cr" uniqKey="Rinaldo C">CR Rinaldo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Grabar, S" uniqKey="Grabar 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uniqKey="Moh R">R Moh</name></author><author><name sortKey="Minga, A" uniqKey="Minga A">A Minga</name></author><author><name sortKey="Anzian, A" uniqKey="Anzian A">A Anzian</name></author><author><name sortKey="Ba Gomis, O" uniqKey="Ba Gomis O">O Ba-Gomis</name></author><author><name sortKey="Kanga, C" uniqKey="Kanga C">C Kanga</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hamlyn, E" uniqKey="Hamlyn E">E Hamlyn</name></author><author><name sortKey="Jones, V" uniqKey="Jones V">V Jones</name></author><author><name sortKey="Porter, K" uniqKey="Porter K">K Porter</name></author><author><name sortKey="Fidler, S" uniqKey="Fidler S">S Fidler</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Australie</li><li>Espagne</li><li>Estonie</li><li>France</li><li>Grèce</li><li>Royaume-Uni</li></country><region><li>Angleterre</li><li>Attique (région)</li><li>Communauté de Madrid</li><li>Grand Londres</li><li>Nouvelle-Galles du Sud</li><li>Île-de-France</li></region><settlement><li>Athènes</li><li>Londres</li><li>Madrid</li><li>Orsay</li><li>Paris</li><li>Sydney</li></settlement><orgName><li>University College de Londres</li><li>Université Paris-Sud</li></orgName></list><tree><country name="Grèce"><region name="Attique (région)"><name sortKey="Pantazis, Nikos" sort="Pantazis, Nikos" uniqKey="Pantazis N" first="Nikos" last="Pantazis">Nikos Pantazis</name></region><name sortKey="Touloumi, Giota" sort="Touloumi, Giota" uniqKey="Touloumi G" first="Giota" last="Touloumi">Giota Touloumi</name></country><country name="France"><region name="Île-de-France"><name sortKey="Meyer, Laurence" sort="Meyer, Laurence" uniqKey="Meyer L" first="Laurence" last="Meyer">Laurence Meyer</name></region><name sortKey="Chaix, Marie Laure" sort="Chaix, Marie Laure" uniqKey="Chaix M" first="Marie-Laure" last="Chaix">Marie-Laure Chaix</name><name sortKey="Costagliola, Dominique" sort="Costagliola, Dominique" uniqKey="Costagliola D" first="Dominique" last="Costagliola">Dominique Costagliola</name></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Olson, Ashley" sort="Olson, Ashley" uniqKey="Olson A" first="Ashley" last="Olson">Ashley Olson</name></region><name sortKey="Fisher, Martin" sort="Fisher, Martin" uniqKey="Fisher M" first="Martin" last="Fisher">Martin Fisher</name><name sortKey="Porter, Kholoud" sort="Porter, Kholoud" uniqKey="Porter K" first="Kholoud" last="Porter">Kholoud Porter</name></country><country name="Australie"><region name="Nouvelle-Galles du Sud"><name sortKey="Kelleher, Anthony D" sort="Kelleher, Anthony D" uniqKey="Kelleher A" first="Anthony D." last="Kelleher">Anthony D. Kelleher</name></region></country><country name="Estonie"><noRegion><name sortKey="Lutsar, Irja" sort="Lutsar, Irja" uniqKey="Lutsar I" first="Irja" last="Lutsar">Irja Lutsar</name></noRegion></country><country name="Espagne"><region name="Communauté de Madrid"><name sortKey="Moreno, Santiago" sort="Moreno, Santiago" uniqKey="Moreno S" first="Santiago" last="Moreno">Santiago Moreno</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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