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Study Examines the Impact of Delaying ART in Patients Diagnosed with HIV

A new study compares the long-term effects of combination ART (cART) initiation during primary HIV infection with therapy initiation during chronic HIV infection.

The World Health Organization (WHO) estimates that there were approximately 36.7 million individuals worldwide living with HIV at the end of 2016. In addition, there were 1.8 million new cases of HIV infection in that same year; around 1 million individuals perished as a result of HIV-related complications.

The WHO also estimates that by mid-2017, there were 20.9 million individuals worldwide who were receiving HIV antiretroviral therapy (ART). In a study published by Oxford University Press for the Infectious Diseases Society of America, lead investigator Sophie Novelli and her colleagues set out to determine the consequences of delaying HIV infection diagnosis. Previous work has shown that receiving combination antiretroviral therapy (cART) during primary HIV infection (PHI) reduces viral infectivity, limits depletion of CD4+ T-lymphocytes, and reduces viral load. However, few studies have addressed the timing of ART initiation. As such, the authors sought to fill this gap by comparing the effects of cART initiation during PHI with initiation during chronic HIV infection.

The study utilized the ARNS PRIMO cohort which enrolled patients with PHI from 95 French hospitals since 1996. Patients were placed into two groups: those in the immediate ART group and those in the deferred ART group. The immediate ART group consisted of patients who initiated cART within the month they were diagnosed with HIV. On the other hand, the deferred ART group consisted of patients who initiated treatment more than 12 months after the estimated date of infection. The study also included 40 healthy blood donors for comparison.

In total, the study looked at 150 patients who were enrolled in the ARNS PRIMO cohort between 1997 and 2009, with 77 in the immediate ART group and 73 in the deferred ART group. Approximately 80% of the patients were Caucasian males.

The authors found that those in the immediate ART group demonstrated a more striking decrease in HIV DNA levels than those in the deferred ART group. In addition, those in the immediate group had improved CD4+ T-cell counts and better CD4:CD8 ratios during the first four years of cART. However, during the patient’s last visit, which, on average, was after 82 months of cART, the authors detected no difference between the two groups in CD4+ T-cell counts, CD4:CD8 ratios, or inflammation/activation marker levels.

The study has some limitations worth mentioning; the authors noted that immunovirological markers were measured at the periphery, which might not have provided an accurate reflection of what was happening in the lymphoid tissues. In addition, the authors note that patients who presented with symptomatic PHI or those who had lower CD4+ T-cell counts were more likely to commence cART during PHI. However, the authors believe this selection was conservative.

Overall, this work provides much-needed information on the long-term effects of delayed HIV diagnosis and deferred ART treatment. The authors were able to show that there are benefits to receiving an early HIV diagnosis and initiating cART during primary HIV infection. However, the authors note that additional strategies are needed in addition to cART to improve long-term outcomes for HIV patients.

Samar Mahmoud graduated from Drew University in 2011 with a BA in Biochemistry and Molecular Biology. After two years of working in the industry as a Quality Control Technician for a blood bank, she went back to school and graduated from Montclair State University in 2016 with an MS in Pharmaceutical Biochemistry. She is currently pursuing a PhD in Molecular and Cellular Biology at the University of Massachusetts at Amherst.