Benefit in early HIV treatment

For years there has been debate about whether starting HIV treatment within a few weeks of seroconversion will have benefits in the long term.

Now a recent Canadian and US study has found that starting treatment within two weeks and stopping 12 weeks later presented trends toward a longer-term benefit, but starting treatment any later showed no long-term effects.

The study, a joint effort by the University of California and seven other institutions, was published in The Journal Of Infectious Diseases. It involved three groups of participants -“ 13 who chose to start highly active antiretroviral treatment (HAART) two weeks after seroconversion (known as acute treatment), 45 who chose to start HAART between two weeks and six months after seroconversion (early treatment) and 337 who refused treatment.

Both treatment groups continued HAART for at least 12 weeks.

The acute treatment group had lower average viral loads and a higher average CD4+ T cell count 24 weeks after ending HAART, compared with the untreated group. Benefits were also recorded 72 weeks after HAART was stopped.

Our results suggest that treatment given during acute HIV infection may modify the long-term course of disease, the study said. However, it stressed the results should be viewed cautiously due to the small sample size and the need for a longer-term follow-up.

The early treatment group also had lower viral loads 24 weeks after ending HAART than the untreated group, yet by 48 weeks there was no significant difference in viral loads between these two groups.

Doctor Robert Finlayson, Sydney sexual health physician and director of Taylor Square Private Clinic, believes the earlier someone receives treatment the better.

I’m known to be an enthusiast for early treatment, he said.

I think most people believe that if treatment of primary HIV infection is going to have any effect that effect will be maximised the earlier it is commenced.

It seems to be a unique time in someone’s infection where you might be able to alter the outcome. Once that moment’s passed the opportunity has passed.

Australia is currently taking part in an international study into acute and early treatment. Finlayson said it is the first study in the world that will randomise people to a no-treatment arm, a treatment for three months arm, and the third arm is treatment for two years.

The study began in November 2004 and is expected to last five years. Around 200 people internationally have so far enrolled and another 160 are being sought.

We really need long-term studies to test the clinical benefit. If you’re treated in the first month after being infected, whether you’re treated for three months, six months or a year, are you going to be better off 10 or 20 years later? Are you going to have less illnesses, defer your first AIDS-defining illness, things like that, Finlayson, who is also chair of the primary HIV infection working group at the National Centre of HIV Epidemiology and Clinical Research, said.

He advised anyone who thinks they may have been at risk of exposure to HIV to see a doctor as soon as possible. They may wish to use PEP, post-exposure prophylaxis, which may help prevent HIV if used within 72 hours of exposure.

If they’ve had a risky exposure and are now having a severe flu-like illness and it’s two to three weeks after the event there’s a high likelihood that might be a seroconversion illness, and the sooner you get to someone who’s familiar with this the sooner you’ll have access to the latest options, he said.