Acute retroviral syndrome is associated with lower CD4+T cell nadir and delayed viral suppression, which are blunted by immediate antiretroviral therapy initiation

Gabert R.; Lama J.R.; Valdez R.; Dasgupta S.; Cabello R.; Sanchez H.; Leon M.; Huamani J.V.; Macrae J.; Montalban E.; Pasalar S.; Ignacio R.B.; Duerr A. · AIDS (2023) · DOI: 10.1097/qad.0000000000003511

Resumen

Objectives:To describe the prevalence of acute retroviral syndrome (ARS) and associated findings during primary HIV, and explore the relationship of ARS to clinical, virological, and immunological outcomes within a longitudinal screen, retest and treat study that minimized ascertainment bias.Design:We evaluated ARS symptoms and signs among 216 persons with acute and early incident HIV within the Sabes study of timing of antiretroviral therapy (ART) initiation during primary HIV in Peru.Methods:We evaluated patient reported symptoms and signs during primary HIV and used logistic regression and generalized linear models to evaluate associations with CD4+and CD8+T cell counts, HIV viral load, and a panel of 23 soluble markers of immune activation.Results:Sixty-one percent of participants had at least one ARS finding and 35% had at least 3. More ARS findings were reported in those enrolled within a month of estimated date of detectable infection (EDDI). Having more ARS signs/symptoms was associated with increased risk of CD4+cell decrease below 350cells/ml within the first 24weeks, failure to suppress HIV viral load, and was most strongly associated with elevated IP-10. Immediate ART blunted effects on symptoms, CD4+cell count and viral load, as associations were strongest in the arm that started ART after 24weeks. Detrimental associations of ARS with CD4+counts, and CD4+/CD8+ratio were not maintained at 2 or 4years.Conclusions:ARS has marked associations with short-term immunologic function and virologic suppression, which were mitigated in participants randomized to initiate ART immediately during primary infection.