{"id":9678,"date":"2004-06-02T14:30:33","date_gmt":"2004-06-02T14:30:33","guid":{"rendered":"http:\/\/i-base.info\/htb\/?p=9678"},"modified":"2014-05-22T17:15:20","modified_gmt":"2014-05-22T17:15:20","slug":"response-to-report-from-11th-croi-on-treatment-in-primary-infection","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/9678","title":{"rendered":"Response to report from 11th CROI on treatment in primary infection"},"content":{"rendered":"

Dr Sarah Fidler<\/strong><\/p>\n

Keith Henry, reporting from the 11th CROI conference, in HTB April 2004, claimed that there is little benefit from treating acute HIV infection.<\/strong> [1]<\/p>\n

This conclusion was based upon data presented by Prof. Bruce Walker and his colleagues, who have reported little clinical advantage from antiretroviral intervention with structured treatment interruption (STI) with\/without vaccine in small cohorts of treated seroconverters over the past 3-5 years [2]. However, none of these studies have been sufficiently powered to address definitively the role played by antiretroviral treatment in acute HIV infection and none have had a randomised untreated comparison arm. Primary HIV infection is very heterogeneous, and leads to a wide range of clinical outcomes. [3] For example, it is reasonably well established that symptomatic seroconversion carries a worse prognosis than asymptomatic seroconversion. HIV-specific CD4+ T-helper responses have been shown to correlate with good virological control in acute infection [4, 5], and several small studies support the hypothesis that preservation of these CD4+ T-helper responses with early ART may influence virological control. [6-9] However, more recent work has demonstrated limited longevity of these responses, although this remains controversial. [10]<\/p>\n

The clinicians\u2019 dilemma as to whether to offer ART intervention in patients presenting with acute HIV infection remains unanswered. The only way to address this is with a large-scale randomised clinical trial appropriately powered to definitively answer this question.<\/p>\n

The Spartac trial, is a Welcome Trust funded 5-year multi-centred randomised study, which started in 2004 with sites in the UK, South Africa, Russia and Australia and will answer this question.<\/p>\n

Clinicians and patients wishing to find more information about taking part in this study should contact Dr Sarah Fidler [s.fidler@imperial.ac.uk<\/a>, Tel: +44 20 7594 3903]; or Dr Judy Fox [Tel: 20 7886 1466] or Mr Ken Legg [Tel: 20 7886 6790] at St Marys Hospital clinical trials unit Paddington, London.<\/p>\n

References:<\/p>\n

    \n
  1. Henry K – Little benefit seen for treatment during acute infection. HTB May 2004.<\/li>\n
  2. Kaufman D, Lichterfeld, Altfeld M., et al. Limited durability of immune control following acute HIV infection. 11 CROI 2004 Oral abstract 24.<\/li>\n
  3. Berrey MM, Schacker T, Collier AC et al. Treatment of primary infection with potent antiretroviral therapy reduces frequency of progression to AIDS. J Infect Dis 2001 183 1466-1475.<\/li>\n
  4. Rosenberg E, Billingsley JM, Caliendo AM et al. Vigorous HIV-1 specific CD4+ T-cell responses associated with control of viraemia. Science 1997 278 1447-1450.<\/li>\n
  5. Gloster SE, Newton P, Cornforth D et al. Association of strong virus-specific CD4 T-cell responses with efficient natural control of primary HIV-1 infection. AIDS 2004 18 749-755.<\/li>\n
  6. Smith D, Walker B, Cooper, D et al. Is antiretroviral treatment of primary HIV infection clinically justified on the basis of current evidence? AIDS 2004 18 709-718.<\/li>\n
  7. Oxenius A, Price D, Easterbrook P, et al. Early highly active antiretroviral therapy for acute HIV-1 infection preserves immune function of CD4+ and CD8+ T-lymphocytes. PNAS 2000 97 3382-338.<\/li>\n
  8. Fidler S, Oxenius, A, Brady M et al. Virological and immunological effects of short course antiretroviral therapy in primary HIV infection. AIDS 2002 16 2049-2054.<\/li>\n
  9. Lillo FB, Ciuffreda D, Veglia F et al. Viral load and burden modification following early antiretroviral therapy of primary HIV-1 infection. AIDS 1999 13, 791-796.<\/li>\n
  10. Fox J, Scriba, et al. The longevity of HIV specific CD4+ T- helper responses following short course antiretroviral therapy in primary HIV infection. Abstract 211, Molecular mechanisms of HIV pathogenesis Keystone, April 2004.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Dr Sarah Fidler Keith Henry, reporting from the 11th CROI conference, in HTB April 2004, claimed that there is little benefit from treating acute HIV infection. [1] This conclusion was based upon data presented by Prof. Bruce Walker and his …<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[19],"tags":[],"class_list":["post-9678","post","type-post","status-publish","format-standard","hentry","category-correspondence"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/9678","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=9678"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/9678\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=9678"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=9678"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=9678"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}