The strongest predictors of immune recovery in patients initiating ART during acute HIV infection was the pre-ART CD4+ to CD8+ ratio and use of first-line INSTI-based ART regimens.
The pre-antiretroviral therapy (ART) ratio of CD4+ to CD8+ and the use of integrase strand transfer inhibitor (INSTI)-based ART regimens are the best predictors of immune recovery among patients with HIV who initiate ART during the acute stage of infection. These findings, from an observational, ambispective study, were published in the International Journal of Infectious Diseases.
A reduction in viral reservoir size has been observed among individuals who initiate ART during the acute stage of HIV infection. However, it remains unclear whether there are additional benefits of early ART initiation, including its effect on immunovirologic response.
Data for this study were sourced between January 1995 and August 2022 from adult patients with acute HIV infection at an outpatient clinic affiliated with a tertiary university hospital in Barcelona, Spain. Researchers evaluated immunovirologic responses among patients on the basis of time to ART initiation after HIV acquisition. Patients initiated ART either within 30 days (very early), between 31 and 180 days (early), or more than 180 days (late) of the estimated date of HIV acquisition. Immune recovery was defined as a CD4+ to CD8+ ratio above 1, and virologic suppression was defined as HIV-1 RNA levels of less than 50 copies/mL. The primary endpoints were time to virologic suppression and immune recovery.
The researchers used Cox proportional hazards regression to determine predictors of immune recovery. Adjustments were made for age at HIV diagnosis, timing of ART initiation; pre-ART CD4+ count, CD4+ to CD8+ ratio, and viral load; sexually transmitted infection history, and use of INSTI-based ART regimens.
Among 147 patients included in the final analysis, the median age was 32 (IQR, 27-40) years, 91.2% were men, and 72.8% were men who have sex with men (MSM). The median estimated date of infection onset to HIV diagnosis was 29 (IQR, 24-99) days, and the median time from diagnosis to ART initiation was 102 (IQR, 5-107) days.
The most common regimen used among the patients was INSTI-based ART (61.9%), followed by non-nucleoside reverse transcriptase inhibitor (NNRTI)- and protease inhibitor (PI)-based ART (16.3% and 14.3%, respectively).
Stratified by ART initiation time, there were 24 very early, 77 early, and 39 late initiations. In general, INSTI-based regimens were more commonly used among patients with very early initiations, whereas NNRTI- and PI-based ART regimens were more commonly used among those with early and late initiations (P <.001).
Prior to ART initiation, the 3 groups significantly differed in regard to viral load, CD4+ T-cell count, CD8+ T-cell count, and CD4+ to CD8+ ratio (all P £.003). The percentage of patients with CD4+ to CD8+ ratios greater than 1 was higher among very early ART initiators (33.3%) when compared with both early (13.0%) and late (2.6%) initiators (P =.003).
At 1 year, analyses of very early, early, and late ART initiators showed significant between-group differences in median CD4+ (930, 775, and 690 cells/µL, respectively; P =.030) and CD8+ (635, 760, and 995 cells/µL, respectively; P =.010) T-cell counts. In the addition, the rate of immune recovery was significantly higher among very early ART initiators when compared with with early and late initiators (68.2% vs 53.2% and 12.8%, respectively; P <.001).
However, at 3 years, there were no significant between-group differences in CD4+ (P =.439) and CD8+ (P =.935) T-cell counts or the rate of immune recovery achievement (range, 30.0%-61.1%; P =.094).
Although time to immune recovery was similar between patients who initiated ART very early vs early (21 vs 29 weeks; P =.0687), patients in both groups achieved immune recovery significantly earlier than late ART initiators (155 weeks; P =.001).
Significant predictors of immune recovery included the pre-ART CD4+ to CD8+ ratio (adjusted hazard ratio [aHR], 9.261; 95% CI, 3.084-27.808; P <.001) and use of INSTI-based ART regimens (aHR, 2.371; 95% CI, 1.344-4.184; P =.003).
These findings may not be generalizable to other populations due to the predominance of MSM. Other limitations include the use of pooled data captured over several decades as HIV management has evolved.
According to the researchers, “A first-line INSTI-based ART regimen could be more effective than other regimens in achieving earlier immune recovery.”
Disclosures: Multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Jessica Nye, PhD
References:
Suanzes P, Navarro J, Rando-Segura A, et al. Impact of very early antiretroviral therapy during acute HIV infection on long-term immunovirological outcomes. Int J Infect Dis. Published online September 17, 2023. doi:10.1016/j.ijid.2023.09.009
Source : Infectious Disease Advisor
Related HIV and Co-Infections News
-
[Press release] FDA grants priority review of New Drug Application for Gilead’s once-daily HIV treatment of bictegravir plus lenacapavir
-
[CROI 2026] HIV i-Base: Investigational HIV combinations – daily, weekly, 4- and 6-monthly…
-
[Press release] FDA approves Merck’s once-daily IDVYNSO™ (doravirine/islatravir)
Get involved
Are you living with HIV/AIDS? Are you part of a community affected by HIV/AIDS and co-infections? Do you work or volunteer in the field? Are you motivated by our cause and interested to support our work?
Subscribe
Stay in the loop and get all the important EATG updates in your inbox with the EATG newsletter. The HIV & co-infections bulletin is your source of handpicked news from the field arriving regularly to your inbox.