Immunological and virological efficacy of different antiretroviral regimens initiated during acute/recent HIV infection

Objectives: Antiretroviral treatment (ART) during acute/recent HIV infection decreases transmission and optimizes immune recovery but the optimal ART-regimen in this setting is unknown. The objectives were to analyze the virological efficacy, immunological reconstitution and tolerability of different ART-regimens at 3 years after starting ART during acute/recent HIV infection. Design: Retrospective cohort study of consecutive acutely/recently infected patients who started ART within 6 months postinfection. Methods: We compared regimens based on protease-inhibitors (N = 28), integrase-strand-transfer-inhibitors (InSTI, N = 87) and nonnucleoside-reverse-transcriptase-inhibitors (N = 22). Virological suppression (viral load <50 copies/ml), immune reconstitution (CD4(+) T-cell count >900 cells/mu l and CD4(+)/CD8(+) ratio >1) and adverse events leading to ART discontinuation at 1 and 3 years were compared. Results: Baseline characteristics were comparable among groups. Overall viral suppression at 1 (96%) and 3 years (99%) was comparable in all ART regimens and, InSTI group, comparable for dolutegravir and elvitegravir within InSTIs. CD4(+) T-cell counts at 1 year were comparable in all ART regimens. Overall proportion of patients reaching CD4(+) cell count more than 900 cells/mu l and CD4(+)/CD8(+) ratio more than 1 was 36% and 40% and 46% and 63% at 1 and 3 years, respectively with no differences among ART regimens. Starting ART during the earliest Fiebig stages (I-V vs. VI) was associated with higher rates of CD4(+) cell count more than 900 cells/mu l at 3 years (P = 0.027). Discontinuation due to adverse events was more frequent with nonnucleoside-reverse-transcriptase-inhibitors compared with other ART classes. Conclusion: Viral suppression and immunological recovery were excellent, with no differences between ART regimens. Earlier ART initiation was associated with a higher proportion of long-term immunological recovery.