Journal
CLINICAL INFECTIOUS DISEASES
Volume 62, Issue 2, Pages 250-257Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/cid/civ809
Keywords
HIV; primary infection; antiretroviral therapy; CD8 T-cell count; CD4/CD8 ratio
Categories
Funding
- Fonds de la Recherche Quebec-Sante (FRQ-S): Therapie Cellulaire and Reseau SIDA/Maladies Infectieuses
- Canadian Institutes of Health Research [MOP 103230, CTN 257]
- Canadian Foundation for AIDS Research (CANFAR) [023-512]
- Canadian HIV Cure Enterprise Team from the CIHR [HIG-133050]
- CANFAR
- CTN postdoctoral fellowship award
- FRQ-S
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Background. CD8 T-cell counts remain elevated in human immunodeficiency virus (HIV) infection even after long-term antiretroviral therapy (ART), which is associated with an increased risk of non-AIDS-related events. We assessed the impact of ART initiation in early versus chronic HIV infection on trajectories of CD8 cell counts over time. Methods. Of 280 individuals enrolled during primary HIV infection (PHI), 251 were followed up for 24 months; 84 started ART before 6 months of infection (eART), 49 started between 6 and 24 months, and 118 remained untreated. Plasma HIV viral load (VL), CD4 and CD8 cell counts were assessed at each study visit. CD8 counts were also examined in 182 age-matched HIV-infected individuals who started ART during chronic infection and maintained undetectable plasma VL for >= 5 years. Results. At PHI baseline, higher CD8 cell counts were associated with more recent infection (P =.02), higher CD4 cell counts (P <.001), and higher VL (P <.001). The CD8 count in the eART group decreased from 797 to 588 cells/mu L over 24 months (P <.001), to a level lower than that in untreated PHI (834 cells/mu L; P =.004) or in long-term-treated patients with chronic HIV infection (743 cells/mu L; P =.047). More prominent CD4 T-cell recovery was observed in the eART group than in the delayed ART group. Conclusions. ART initiated in early HIV infection is associated with improved resolution of CD8 T-cell elevation compared with long-term ART initiated in chronic infection. Early ART may help reduce the risk of non-AIDS-related events by alleviating this elevation.
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