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Initiating ART During Acute HIV Infection Affects Trajectory of Viral Load

July 11, 2017

In a study comparing viral load in individuals during acute HIV infection, those who began antiretroviral therapy (ART) immediately had dramatically lower viral loads compared to those who did not immediately begin therapy. Findings from the study were published last week in the Journal of the International AIDS Society.

The extent of viral replication during acute HIV infection (AHI) influences HIV disease progression. However, information comparing viral load with and without ART during AHI is limited.

A new analysis, led by researchers from the U.S. Military HIV Research Program (MHRP), examined viral load data captured during the first year of HIV infection from two MHRP-led cohort studies in Thailand: the RV217 study and the RV254 study.

RV217 is a prospective cohort of individuals at high risk for HIV who are screened for AHI with twice-weekly. ART is initiated according to standard of care at local health centers, and none in this analysis had begun ART. The RV254 cohort enrolls individuals diagnosed with AHI at an HIV testing center that has routine AHI screening, and they are offered immediate ART.

Analysis in the new study showed that HIV replication is halted soon after ART initiation, resulting in an early divergence of viral load trajectories between the treated and untreated volunteers. By day 12 of the new study (4 days after ART began in RV254 volunteers), the untreated group had a 2.7-fold higher viral load level compared to those treated. These differences increased to 135-fold by day 30 and 1148-fold by day 120.

“Initiating ART in AHI dramatically changed the trajectory of viral load very early in the course of infection, which could have implications for reducing potential to transmit HIV and enhancing responses to future HIV remission strategies,” said Dr. Jintanat Ananworanich, MHRP’s Associate Director for Therapeutics Research and protocol chair of RV254.

Inhibiting viral replication infection prevents viral mutation, and reduces immune destruction, seeding of the latent HIV reservoir and immune activation. If inhibited early enough, this could potentially have a significant impact on the progression of disease.

“There is an urgency to initiate ART when acute infection is identified,” said Dr. Merlin Robb, MHRP’s Clinical Deputy Director and senior author of the paper. “New and inexpensive strategies to engage and test individuals at high risk for HIV as well as immediate treatment access will be needed to improve the treatment of acute infection globally.”