Outcomes of acutely HIV-1 infected individuals following rapid antiretroviral therapy initiation

Nicolò Girometti

BACKGROUND: Few data exist on the benefits and acceptability of rapid initiation of antiretroviral treatment in acute HIV infection (AHI). We analyzed a large cohort of acutely infected HIV patients starting antiretroviral therapy (ART) to determine uptake, linkage into care and time to achieve viral suppression.

METHODS: Case-notes of all individuals diagnosed with AHI between May 2014 and October 2015 at 56 Dean Street, a sexual health clinic in London, UK were reviewed. AHI was defined through documentation of plasma HIV-RNA positivity only, plasma HIV-RNA and p24 antigen positivity with a negative HIV enzyme immunoassay (EIA) test, or HIV EIA test switching from negative to positive within six weeks. Between-group comparisons of time to viral suppression according to ART chosen were performed using the log-rank test.
RESULTS: We identified 113 individuals with AHI. Linkage to care was 95%. 77% patients started ART at first medical appointment: all MSM, median age 35 years, median viral load (VL) log10 6.45, median CD4 483 cells/mm3. Median time from diagnosis to ART initiation was 20 days. At 24 weeks, no patients had discontinued ART; 99% of patients achieved viral suppression by 24 weeks, with a median time to documented VL suppression of 74 days. Viral suppression was more rapid with integrase inhibitors (INI) compared with other regimens (median 41 vs. 88.5 days, p<0.05).
CONCLUSIONS: In acute HIV infection, individuals demonstrated high ART uptake and rapid VL suppression suggesting that early treatment with ARV is acceptable and efficacious.

Simone Agnello
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