Antiretroviral treatment early in first stage of HIV infection adds to lasting impact on viral burden

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The sooner a patient recently infected with HIV began antiretroviral treatment, the faster the burden of the virus dropped, leading to a measurable benefit five years later, a study recently released in Clinical Infectious Diseases says.

The study examined outcomes among 327 patients in what, to the researchers’ knowledge, is the largest group of study participants followed from the first stage of HIV infection and for whom frozen blood samples remained available. The findings support arguments to begin treatment as soon as possible following infection, the authors say. The median time between becoming infected with HIV and starting combined antiretroviral treatment among the patients was 41 days, according to the authors.

The first stage of HIV infection is one characterized by rapid replication of the virus, strong immune responses, and symptoms that include fever, swollen glands, headaches and are similar to the flu. While previous studies have indicated that starting antiretroviral treatment in that first stage of HIV infection controlled the virus more efficiently than starting during a later phase of infection, this study showed that the earlier in that first stage that patients started antiretroviral treatment also made a difference over time, with patients who started treatment 15 days after infection showing evidence of a smaller viral reservoir five years later than patients who started treatment three months after infection. Their viral reservoir levels were comparable, the authors wrote, to levels found among HIV controllers, rare individuals who maintain undetectable viral loads without treatment.

In addition to highlighting the benefits of early treatment, the findings underscore the importance of early HIV diagnosis and add impetus to accelerating provision of early diagnosis particularly among people exposed to high risks, the authors note.

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