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Similaire à Primary HIV: Early Treatment Benefits Viral Control
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Primary HIV: Early Treatment Benefits Viral Control
- 1. Primary HIV Infection and Prevention Rachel Baden, M.D. Division of Infectious Diseases Beth Israel Deaconess Medical Center Harvard Medical School
- 7. Natural course of HIV infection
- 12. “ Sam”: Should treatment be started?
- 17. Kassutto et al, CID 2006 Comparison of mean CD4+ T lymphocyte counts over time in treated vs untreated acute/early HIV-1 infection baseline 6 12 24 36 0 100 200 300 400 500 600 700 800 Treated cohort MACS CD4+ T lymphocyte count (cells/mm 3) P=0.01 P=0.001 P=0.0007 Time (months)
- 19. Goal of early therapy- delay progression HIV Viral Load 1 year Rapid Progression Slow Progression Mellors et al, Annals 1997 Natural history (MACS cohort) Early treatment may change the viral set point and preserve immune function-shift patient to lower curve
- 20. PRIMO vs. SEROCO Does treatment affect set point? Desquilbet et al, AIDS 20004 N=58 N=116
- 26. The epidemiology of transmission Wawer et al, JID 2005 Brenner et al, JID 2007 Quebec study: Early infection accounts for approximately 50% of new transmissions Transmission is 10-12x higher in early infection
- 28. Awareness of Serostatus Among People With HIV and Estimates of Transmission ~25% Unaware of infection ~75% Aware of infection People Living with HIV/AIDS: 1,039,000–1,185,000 New Sexual Infections Each Year: ~32,000 Accounting for: ~54% of new infections ~46% of new infections Marks et al. AIDS . 2006;20:1447-1450.
- 31. Which ARVs should be used to treat acute HIV infection? 3 drug regimen: Tenofovir/FTC +AZT or Darunavir/Rit vs 5 drug regimen:Tenofovir/FTC/ PI +Maroviroc/Raltegravir No difference was found in response rates, plasma viral loads or immune reconstitution between the two regimens. Studies on GI tract and other reservoirs still pending Markowitz et al. CROI 2011
- 33. A PHASE I CLINICAL TRIAL TO EVALUATE THE INITIATION OF TREATMENT VERSUS NO TREATMENT DURING ACUTE HIV-1 INFECTION A Single Center Trial of the Partners AIDS Research Center and the Division of Infectious Disease at Massachusetts General Hospital 617-724-0070
Notes de l'éditeur
- Perhaps the best evidence that control of HIV infection is relative is from data generated from the MACS cohort in which it has been shown that within 6-12 months of primary HIV infection, the level at which virus reaches equilibrium or “set-point” is highly prognostic for how quickly or slowly a person will progress. In persons with the highest viral load set-point….
- It is estimated that sexual transmission accounts for 32,000 of the 40,000 new infections each year. Conservative estimates based on the changes in behavior observed once people find out they are infected with HIV indicate that the 25% of people who are unaware that they are infected account for at least 54%, and potentially as much as 70%, of the new sexually transmitted infections each year. The transmission rate among those who don’t know they are infected is 3.5 times higher than for people who know about their HIV infection. The importance of getting these individuals tested and into care that includes both treatment and prevention interventions is critical.
- These are data from San Francisco DPH demonstrating what’s being referred to as “community viral load” in log copies/mL on the X axis and new HIV diagnoses on the Z axis. Unfrotunately, no denominator data. Period was from 2004 to 2008. SF was a demonstration site in 2004-5 for verbal consent, and in 2006, went to opt-out testing. The take homes here are: 1) verbal consent was effective; 2) the community viral loads early in the demonstration were high– around 100,000 copies/mL at time of diagnosis– by 2008, the viral loads were around 15,000 copies/mL. The biologic impact of this is lower transmission rates (transmission is directly tied to types of risk behaviors and viral load). I can’t say more about this– the SF DPH is very careful to say the data are not robust enough to say they’re affecting HIV incidence yet, though the trend would suggest this.
- These are data from British Columbia, Canada (includes Vancouver– very high HIV rates). The Canadians use an opt-out, verbal discussion testing format that started I believe in the mid 2000s. They’re finding trends similar to the SF DPH– community viral load down, getting more and more people on ARVs earlier, and the public health impact has been a persistently falling new case rate– in spite of continued high-risk behavior as indicated by the other STD rates (increasing syphilis, GC and chlamydia rates– generally used as surrogates for unprotected sex exposures).