Similar results with continuous and intermittent ART for primary HIV
Patients with primary HIV-1 infection show similar high response rates and sustained immunological benefits with continuous and intermittent antiretroviral treatment strategies.
NEW YORK (Reuters Health) Aug 09 - Patients with primary HIV-1 infection show similar high response rates and sustained immunological benefits with continuous and intermittent antiretroviral treatment (ART) strategies, according to a new paper..
In a randomized trial with 89 patients, Dr. Cecile Goujard from Hopital Bicetre, Le Kremlin Bicetre, France, and colleagues in the ANRS-112 INTERPRIM study group compared two sequential ART regimens (with or without peg-interferon) to continuous ART.
The researchers hoped treatment interruptions would improve HIV-specific responses and adding peg-interferon would further enhance the effect. The choice of ART was up to the treating physician, but in the interruption groups, patients received ART for 36 weeks, followed by four-week interruptions at week 36, week 48, and week 60.
Patients allocated to the interferon group received it for the first 14 weeks and then for three more four-week periods, starting two weeks into each interruption.
HIV-RNA levels declined upon treatment initiation and rebounded upon each ART interruption, but median HIV-RNA levels six months after the last interruption did not differ among continuous ART and intermittent ART with or without peg-interferon.
Cellular HIV-DNA levels followed a similar pattern, according to the July 26 online report in AIDS.
Similarly, CD4+ T cell counts increased rapidly with ART alone, but more slowly with treatment interruption combined with peg-interferon. Although CD4+ T cell counts fell with treatment interruptions, beyond week 24 they stayed above baseline level and did not differ among the three treatment strategies.
CD4+ T lymphocyte function improved rapidly in all three groups and remained stable up to week 72.
Adverse events were more frequent and tended to be more serious in patients who also received interferon.
Among 65 patients followed for up to 54 months, ART had to be resumed in 48% of patients with a similar frequency and median time (9.9 months) between groups.
"Treatment interruptions, whether associated or not with interferon, did not improve immune responses nor reinforce control of HIV replication in very early treated patients," the researchers conclude.
"As long as we have no strategy capable of containing residual HIV replication after ART interruption or leading to HIV cure, current antiretroviral therapies might be prolonged from primary infection for life," they say.
Dr. Goujard could not be reached for comment.
Source: Medscape Today