Rajesh T. Gandhi, MD

Initiating antiretroviral therapy within the first year of infection improved immune reconstitution and function in a U.S. military cohort.

Although most HIV-infected patients receiving antiretroviral therapy (ART) achieve an undetectable viral load, many do not attain a normal CD4-cell count. To assess how timing of ART initiation affects CD4-cell recovery, investigators evaluated immune reconstitution in 1199 HIV-infected U.S. Military HIV Natural History Study participants who had achieved an undetectable viral load (median pre-ART CD4-cell count, 358 cells/mm3). CD4-cell normalization was defined as achieving a count of >900 cells/mm3 (based on values from HIV-uninfected persons).

After virologic suppression for a median of 4.7 years, only 31% of participants achieved CD4-cell normalization. Normalization was significantly more common in patients who had initiated ART within 12 months of the estimated date of seroconversion than in those who had started ART later than that (38.4% vs. 28.3%). Compared with later initiators, early initiators had lower rates of developing AIDS (7.8% vs. 15.3%), lower levels of T-cell activation, and higher rates of response to hepatitis B vaccine (67.9% vs. 50.9%).

Citation(s):

Okulicz JF et al. Influence of the timing of antiretroviral therapy on the potential for normalization of immune status in human immunodeficiency virus 1–infected individuals. JAMA Intern Med 2014 Nov 24; [e-pub ahead of print].

Schacker TW et al. Defining success with antiretroviral therapy. JAMA Intern Med 2014 Nov 24; [e-pub ahead of print].