In the Journals

Deferring ART more than 1 year reduced chance of immune recovery

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December 3, 2014

Deferring antiretroviral therapy more than 12 months after the estimated date of seroconversion reduced the possibility of restoring the immune system among people with HIV, according to new data.

“We demonstrated in the present study that there is a narrow time window after acquiring HIV infection within which the commencement of ART favors CD4+ normalization,” the researchers wrote in JAMA Internal Medicine. “Achieving CD4+ normalization is an imminently feasible therapeutic goal, provided ART is started within 12 months of the estimated date of seroconversion at higher CD4+ counts.”

Jason F. Okulicz, MD, of the Infectious Disease Clinical Research Program of the Uniformed Services University of the Health Sciences, and colleagues used data from the US Military HIV Natural History Study to examine CD4+ normalization and AIDS outcomes in 1,119 participants who had estimated dates of seroconversion.

They found that 38.4% of patients who initiated ART within 12 months of the estimated date of seroconversion achieved CD4+ normalization compared with 28.3% of those who initiated ART after 12 months. Higher CD4+ recovery was associated with decreases in AIDS risk and reversion of markers of immune activation, dysfunction and responsiveness to levels found among uninfected individuals.

Among individuals with CD4 counts of 500 cell/mcL or greater at study entry or ART initiation, the rate of CD4+ normalization was higher compared with others. But individuals with a CD4+ count of 500 cells/mcL or higher who initiated ART more than 12 months after estimated date of seroconversion or study entry had an 80% lower chance of CD4+ normalization (adjusted OR=0.2; 95% CI, 0.07-0.53). ART initiation within 12 months of estimated date of seroconversion was significantly associated with a reduced risk for AIDS, reduced T-cell activation and increased responsiveness to hepatitis B vaccine.

“The importance of a public health strategy that includes frequent HIV testing in persons at risk and prompt initiation of ART after diagnosis is underscored by two findings: the rate of unwitnessed CD4+ count decline that occurs in the interval between HIV acquisition and diagnosis cannot be predicted, and the duration of infection cannot be predicted by the CD4+ count,” the researchers wrote.

Disclosure: Some researchers report financial relationships with Abbott, Biota Pharmaceuticals, Boehringer Ingelheim, Bristol-Myers Squibb, Chimerix, Cilag, Genprobe, Gilead Sciences, Janssen, Monogram Biosciences, Merck, Pfizer, Prism Pharmaceuticals, Sirenas Marine Discovery and ViiV.

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