The impact of transient combination antiretroviral treatment in early HIV infection on viral suppression and immunologic response in later treatment
Identifieur interne : 000505 ( Pmc/Curation ); précédent : 000504; suivant : 000506The 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
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Kelleher</name><affiliation wicri:level="1"><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></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></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="1"><nlm:aff id="aff9">Laboratoire de Virologie, Hopital Saint Louis, Universite Paris Diderot, INSERM U941, Paris, France</nlm:aff><country 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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></affiliation></author><author><name sortKey="Porter, Kholoud" sort="Porter, Kholoud" uniqKey="Porter K" first="Kholoud" last="Porter">Kholoud Porter</name><affiliation wicri:level="1"><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></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26636925</idno><idno type="pmc">4794189</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4794189</idno><idno type="RBID">PMC:4794189</idno><idno type="doi">10.1097/QAD.0000000000000991</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">000505</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000505</idno><idno type="wicri:Area/Pmc/Curation">000505</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000505</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The impact of transient combination antiretroviral treatment in early HIV infection on viral suppression and immunologic response in later treatment</title><author><name sortKey="Pantazis, Nikos" sort="Pantazis, Nikos" uniqKey="Pantazis N" first="Nikos" last="Pantazis">Nikos Pantazis</name><affiliation wicri:level="1"><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></affiliation></author><author><name sortKey="Touloumi, Giota" sort="Touloumi, Giota" uniqKey="Touloumi G" first="Giota" last="Touloumi">Giota Touloumi</name><affiliation wicri:level="1"><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></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="1"><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></affiliation></author><author><name sortKey="Olson, Ashley" sort="Olson, Ashley" uniqKey="Olson A" first="Ashley" last="Olson">Ashley Olson</name><affiliation wicri:level="1"><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></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="1"><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></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="1"><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></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></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="1"><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></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></affiliation></author><author><name sortKey="Moreno, Santiago" sort="Moreno, Santiago" uniqKey="Moreno S" first="Santiago" last="Moreno">Santiago Moreno</name><affiliation wicri:level="1"><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></affiliation></author><author><name sortKey="Porter, Kholoud" sort="Porter, Kholoud" uniqKey="Porter K" first="Kholoud" last="Porter">Kholoud Porter</name><affiliation wicri:level="1"><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></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><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">AIDS</journal-id><journal-id journal-id-type="iso-abbrev">AIDS</journal-id><journal-id journal-id-type="publisher-id">AIDS</journal-id><journal-title-group><journal-title>AIDS (London, England)</journal-title></journal-title-group><issn pub-type="ppub">0269-9370</issn><issn pub-type="epub">1473-5571</issn><publisher><publisher-name>Lippincott Williams & Wilkins</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26636925</article-id><article-id pub-id-type="pmc">4794189</article-id><article-id pub-id-type="doi">10.1097/QAD.0000000000000991</article-id><article-categories><subj-group subj-group-type="heading"><subject>Clinical Science</subject></subj-group></article-categories><title-group><article-title>The impact of transient combination antiretroviral treatment in early HIV infection on viral suppression and immunologic response in later treatment</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Pantazis</surname><given-names>Nikos</given-names></name><xref ref-type="aff" rid="aff1"><sup>a</sup></xref></contrib><contrib contrib-type="author"><name><surname>Touloumi</surname><given-names>Giota</given-names></name><xref ref-type="aff" rid="aff1"><sup>a</sup></xref></contrib><contrib contrib-type="author"><name><surname>Meyer</surname><given-names>Laurence</given-names></name><xref ref-type="aff" rid="aff2"><sup>b</sup></xref><xref ref-type="aff" rid="aff3"><sup>c</sup></xref></contrib><contrib contrib-type="author"><name><surname>Olson</surname><given-names>Ashley</given-names></name><xref ref-type="aff" rid="aff4"><sup>d</sup></xref></contrib><contrib contrib-type="author"><name><surname>Costagliola</surname><given-names>Dominique</given-names></name><xref ref-type="aff" rid="aff5"><sup>e</sup></xref><xref ref-type="aff" rid="aff6"><sup>f</sup></xref></contrib><contrib contrib-type="author"><name><surname>Kelleher</surname><given-names>Anthony D.</given-names></name><xref ref-type="aff" rid="aff7"><sup>g</sup></xref></contrib><contrib contrib-type="author"><name><surname>Lutsar</surname><given-names>Irja</given-names></name><xref ref-type="aff" rid="aff8"><sup>h</sup></xref></contrib><contrib contrib-type="author"><name><surname>Chaix</surname><given-names>Marie-Laure</given-names></name><xref ref-type="aff" rid="aff9"><sup>i</sup></xref></contrib><contrib contrib-type="author"><name><surname>Fisher</surname><given-names>Martin</given-names></name><xref ref-type="aff" rid="aff10"><sup>j</sup></xref></contrib><contrib contrib-type="author"><name><surname>Moreno</surname><given-names>Santiago</given-names></name><xref ref-type="aff" rid="aff11"><sup>k</sup></xref></contrib><contrib contrib-type="author"><name><surname>Porter</surname><given-names>Kholoud</given-names></name><xref ref-type="aff" rid="aff4"><sup>d</sup></xref></contrib><on-behalf-of>on behalf of CASCADE Collaboration in EuroCoord
</on-behalf-of><xref rid="fn1"><sup>∗</sup></xref></contrib-group><aff id="aff1"><label>a</label>Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece</aff><aff id="aff2"><label>b</label>Faculte de Medecine Paris Sud</aff><aff id="aff3"><label>c</label>INSERM U1018, Centre de recherche en Epidemiologie et Sante des Populations, Universite Paris Sud, Le Kremlin Bicetre, France</aff><aff id="aff4"><label>d</label>Medical Research Council Clinical Trials Unit, University College London, London, UK</aff><aff id="aff5"><label>e</label>INSERM</aff><aff id="aff6"><label>f</label>Sorbonne Universités, UPMC Univ Paris 06, UMRS 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France</aff><aff id="aff7"><label>g</label>Kirby Institute, UNSW, Sydney, Australia</aff><aff id="aff8"><label>h</label>Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia</aff><aff id="aff9"><label>i</label>Laboratoire de Virologie, Hopital Saint Louis, Universite Paris Diderot, INSERM U941, Paris, France</aff><aff id="aff10"><label>j</label>HIV/GUM Research, Brighton and Sussex University Hospitals NHS Trust, Brighton and Sussex Medical School, Brighton, UK</aff><aff id="aff11"><label>k</label>Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain.</aff><author-notes><corresp>Correspondence to Nikos Pantazis, Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, 115 27 Athens, Greece. Tel: +302107462088; fax: +302107462205; e-mail: <email>npantaz@med.uoa.gr</email></corresp></author-notes><pub-date pub-type="ppub"><day>27</day><month>3</month><year>2016</year></pub-date><pub-date pub-type="epub"><day>07</day><month>3</month><year>2016</year></pub-date><volume>30</volume><issue>6</issue><fpage>879</fpage><lpage>888</lpage><history><date date-type="received"><day>05</day><month>10</month><year>2015</year></date><date date-type="rev-recd"><day>12</day><month>11</month><year>2015</year></date><date date-type="accepted"><day>12</day><month>11</month><year>2015</year></date></history><permissions><copyright-statement>Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.</copyright-statement><copyright-year>2016</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/4.0"><license-p>This is an open access article distributed under the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0">http://creativecommons.org/licenses/by/4.0</ext-link></license-p></license></permissions><self-uri xlink:type="simple" xlink:href="aids-30-879.pdf"></self-uri><abstract><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></abstract><kwd-group><title>Keywords</title><kwd>early/primary HIV infection</kwd><kwd>immunologic response</kwd><kwd>transient combination antiretroviral treatment</kwd><kwd>treatment reinitiation</kwd><kwd>virologic response</kwd></kwd-group><custom-meta-group><custom-meta><meta-name>OPEN-ACCESS</meta-name><meta-value>TRUE</meta-value></custom-meta></custom-meta-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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