Gay Cynthia L, Keys Jessica, Kuruc JoAnn D, Sponaugle Alexis, McGee Kara S, Ang Chelston, Baker Caroline E, Weimer Eric T, Schmitz John L, Archin Nancie M, McKellar Mehri S, Goonetilleke Nilu, Margolis David M, Eron Joseph J
Department of Medicine, University of North Carolina at Chapel Hill (UNC) School of Medicine, Chapel Hill, North Carolina, USA.
UNC Chapel Hill HIV Cure Center, University of North Carolina at Chapel Hilll, Chapel Hill, North Carolina, USA.
Open Forum Infect Dis. 2025 Apr 24;12(5):ofaf247. doi: 10.1093/ofid/ofaf247. eCollection 2025 May.
We evaluated rapid start of integrase-based antiretroviral therapy (ART) during acute HIV-1.
Adult participants initiated co-formulated dolutegravir/abacavir/lamivudine within 30 days of acute HIV-1 diagnosis. HLA-B*57-positive participants were excluded by rapid, flow cytometry screening. We evaluated HIV-1 RNA levels, CD4+ T-cell subsets, and change in replication competent HIV-1.
Forty adults screened with 3 excluded due to positive HLA-B57:01 or hepatitis B surface antigen results. All 37 participants starting study treatment suppressed to <200 copies/mL by week 24 (median of 4 weeks, interquartile range 3.4-5.1); 86% and 95% were <50 copies/mL at weeks 48 and 96, respectively. We observed a median 2.4-fold decline in frequency of resting CD4+ T-cell infection in a subset of participants providing 96 week samples. ART in acute HIV-1 resulted in CD4+ T-cell memory subpopulations similar to people without HIV-1 and preserved CD4+ and CD8+ T-cell frequencies compared to people starting ART in chronic HIV. Thirty-four participants required rapid HLA-B57 testing at screening; 97% resulted ≤24 hours, and 71% started ART ≤24 hours.
Integrase-based ART during acute HIV-1 resulted in brisk viral suppression, preservation of CD4+ T-cell subsets, and decline in resting CD4+ T-cell infection.
我们评估了在急性HIV-1感染期间基于整合酶的抗逆转录病毒疗法（ART）的快速启动情况。
成年参与者在急性HIV-1诊断后的30天内开始使用多替拉韦/阿巴卡韦/拉米夫定复方制剂。通过快速流式细胞术筛查排除HLA-B*57阳性的参与者。我们评估了HIV-1 RNA水平、CD4+ T细胞亚群以及具有复制能力的HIV-1的变化。
40名成年人接受筛查，3名因HLA-B57:01阳性或乙肝表面抗原结果而被排除。所有37名开始研究治疗的参与者在第24周时病毒载量均被抑制至<200拷贝/毫升（中位数为4周，四分位间距为3.4 - 5.1）；在第48周和第96周时，分别有86%和95%的参与者病毒载量<50拷贝/毫升。在提供96周样本的一部分参与者中，我们观察到静息CD4+ T细胞感染频率中位数下降了2.4倍。急性HIV-1感染时开始ART导致CD4+ T细胞记忆亚群与未感染HIV-1的人相似，与慢性HIV感染时开始ART的人相比，CD4+和CD8+ T细胞频率得以保留。34名参与者在筛查时需要进行快速HLA-B57检测；97%的检测结果在≤24小时内得出，71%的参与者在≤24小时内开始ART。
急性HIV-1感染期间基于整合酶的ART导致病毒快速抑制、CD4+ T细胞亚群得以保留以及静息CD4+ T细胞感染减少。
