A HAART regimen based on the non-nucleoside (NNRTI) efavirenz is a virologically and immunologically effective and safe treatment for primary HIV infection, according to a small UK study published in the February edition of HIV Medicine. Although the investigators admit that the long-term benefits of treating primary infection are not known, they noted significant improvements in immune function during treatment, suggesting that NNRTI-based treatment of primary infection results in immune reconstitution.
Investigators at the UK’s largest HIV clinic, the Kobler Centre at the Chelsea and Westminster Hospital in London, recruited 21 gay men who had been recently infected with HIV between 1999 and 2001 to evaluate the virological and immunological efficacy of a HAART regimen including efavirenz and AZT and 3TC (dosed together as Combivir). Safety data were also gathered in the study, which lasted twelve months.
The men had a median age of 35.5 years, and it was calculated that the men presented for treatment a median of 47 days after their exposure to HIV. At baseline the median HIV viral load was a little over 116,000 copies/mL. Therapy was started a mean of eight days after initial presentation to the clinic. One man withdrew from the study and one man was lost to follow-up. The remaining 19 men remained on the study for twelve months.
All these 19 men achieved an undetectable HIV viral load (below 50 copies/mL) in a median of twelve weeks.
There was also a trend towards an increase in CD4 lymphocytes and CD16/56 cells during therapy. CD8 cell count increased at the time of maximum HIV viral load before slowly declining.
Vivid dreams were reported by 24% of individuals, and this was the most frequently reported side-effect. One patient stopped treatment completely, one switched to Trizivir after complaining of feeling generally unwell, and one patient changed to nevirapine-based HAART after complaining of drowsiness on efavirenz.
The investigators comment that “we have shown that NNRTI-based therapy in primary infection led to a rapid and sustained decline in HIV-1 viral load, with preservation of CD4, CD8 and CD16/56 counts.” They add, “our data show a rapid decrease in CD8, CD38 T cells and CD38 molecules per CD8 T cell, further suggesting that NNRTI-based HAART for primary HIV-1 infection results in immune reconstitution.”
Further information on this website
Portsmouth S et al. Treatment of primary HIV-1 infection with nonnucleoside reverse transcriptase inhibitor-based therapy is effective and well tolerated. HIV Medicine 5: 26 – 29, 2004.