Immune Control of HIV-1 After Early Treatment of Acute Infection [Rosenberg ES, et al. Nature 2000;407:523]: The study involved 16 patients at the Massachusettes General Hospital in Boston who were treated during symptomatic acute HIV infection. All were given HAART, and most received this therapy within 72 hours of diagnosis. Eight patients had a structured treatment interruption after 383 - 1,081 days of treatment. All subjects had detectable virus after a median of 17 days. Following treatment interruption, the viral load decreased and remained below 500 copies/mL in five patients for a median follow-up period of 6.5 months (range of 5.0 - 8.7 mo.). Five of the patients had to restart therapy due to high viral loads, but then had virologic control after a second treatment interruption. Immunologic studies showed HIV-1 specific CD4 and CD8 T-cell responses were enhanced, and this was the presumed mechanism of virologic control.
Comment: This is the work being done at the laboratory of Bruce Walker and colleagues showing the results of studies that have been presented at several meetings This experience is analogous to that reported for the "Berlin patient" [NEJM 1999;340:1683] who was also treated during the acute retrovirus syndrome and had sustained virologic control off therapy. The results here appear to be substantially better than noted with STI for patients with chronic HIV infection, a clinical observation that is consistent with the hypothesis of Bruce Walker, et al. In an editorial comment, it was noted that these results may require rethinking of HIV treatment guidelines from the UK, which recommend antiretroviral therapy only when the CD4 cell count is <350/mm³ [Nature 2000;407:434]. These results also emphasize the importance of recognizing the acute retroviral syndrome. posted 10/19/2000