Christine Hogan, MD, of the Medical College of Wisconsin in Milwaukee, led a team of researchers from various institutions to investigate the effects of ART on individuals infected with HIV-1 within the previous six months.
The multicenter clinical trial—the AIDS Clinical Trials Group (ACTG) Setpoint Study—enrolled 130 men and non-pregnant women who were at least 18 years old and had not received ART previously. Participants were randomized into two groups: In the immediate treatment group, patients were to receive ART treatment for 36 weeks, after which treatment was stopped; treatment was deferred for patients in the second group. All individuals were followed throughout the study.
The study's primary endpoint was the patients' virologic setpoint at 72 weeks. The researchers also sought to compare the virologic setpoint at 72 weeks for patients in the immediate treatment group with that of patients in the deferred treatment group at 36 weeks.
Investigators found that the immediate treatment group had a better outcome than the deferred group. Individuals in the deferred arm experienced higher than anticipated rates of disease progression, necessitating the start of HIV treatment before the study endpoint. Half of the participants in the deferred treatment group required treatment on medical grounds within 18 months.
According to Dr. Hogan and colleagues, the results suggest that "if immediate therapy is not begun, progression to meeting standard criteria for ART initiation may occur more rapidly than expected, especially with changing treatment paradigms." In addition, patients who received treatment immediately appear to have been protected not only during treatment but for a brief period of time afterward.
In an accompanying editorial, Harout Tossonian, MD, PhD, and Brian Conway, MD, of the University of British Columbia in Vancouver, Canada, noted that "immune preservation and reduction in the latent pool of HIV-1-carrying CD4 T-cells seems to require intervention at the earliest possible time of acute infection." They noted that the advantages of immediate treatment appear to be achieved with little to no harm to the patient, either in terms of drug-related toxicity or emergence of drug resistance. "The initial course of 36 weeks of treatment may delay the need for re-starting it more than the 36 weeks spent on it from the time of initial presentation," Drs. Tossonian and Conway wrote. "Thus over the lifetime of the patient, there will be less cumulative drug exposure."
Dr. Hogan and her team suggest that the findings may be of interest to clinicians and patients struggling with when to begin ART. An additional sub-study is underway "to address whether immediate versus deferred treatment during primary HIV infection results in improvements in markers of inflammation and immune activation, which may provide further insight into potential benefits of treating primary infection," the authors wrote.
1) In a comparative randomized trial of immediate versus deferred antiretroviral therapy (ART) in early HIV infection, patients whose therapy was deferred experienced higher than anticipated rates of disease progression.
2) Participants who received treatment immediately appear to have been protected not only during treatment but also for a brief period of time after treatment was stopped.
The study and the accompanying editorial are available online. They are embargoed until 12:01 a.m. EST on Friday, Dec. 16, 2011:
The Setpoint Study (ACTG A5217): Effect of Immediate Versus Deferred Antiretroviral Therapy on Virologic Set Point in Recently HIV-1–Infected Individuals
Recent HIV-1 Infection: To Treat or Not to Treat, That Is the Question
Published continuously since 1904, the Journal of Infectious Diseases is the premier global journal for original research on infectious diseases. The editors welcome major articles and brief reports describing research results on microbiology, immunology, epidemiology, and related disciplines, on the pathogenesis, diagnosis, and treatment of infectious diseases; on the microbes that cause them; and on disorders of host immune responses. The journal is an official publication of the Infectious Diseases Society of America (IDSA). Based in Arlington, Va., IDSA is a professional society representing more than 9,000 physicians and scientists who specialize in infectious diseases. For more information, visit http://www.idsociety.org.
John Heys | EurekAlert!
Smart Data Transformation – Surfing the Big Wave
02.12.2016 | Fraunhofer-Institut für Angewandte Informationstechnik FIT
Climate change could outpace EPA Lake Champlain protections
18.11.2016 | University of Vermont
In recent years, lasers with ultrashort pulses (USP) down to the femtosecond range have become established on an industrial scale. They could advance some applications with the much-lauded “cold ablation” – if that meant they would then achieve more throughput. A new generation of process engineering that will address this issue in particular will be discussed at the “4th UKP Workshop – Ultrafast Laser Technology” in April 2017.
Even back in the 1990s, scientists were comparing materials processing with nanosecond, picosecond and femtosesecond pulses. The result was surprising:...
Have you ever wondered how you see the world? Vision is about photons of light, which are packets of energy, interacting with the atoms or molecules in what...
A multi-institutional research collaboration has created a novel approach for fabricating three-dimensional micro-optics through the shape-defined formation of porous silicon (PSi), with broad impacts in integrated optoelectronics, imaging, and photovoltaics.
Working with colleagues at Stanford and The Dow Chemical Company, researchers at the University of Illinois at Urbana-Champaign fabricated 3-D birefringent...
In experiments with magnetic atoms conducted at extremely low temperatures, scientists have demonstrated a unique phase of matter: The atoms form a new type of quantum liquid or quantum droplet state. These so called quantum droplets may preserve their form in absence of external confinement because of quantum effects. The joint team of experimental physicists from Innsbruck and theoretical physicists from Hannover report on their findings in the journal Physical Review X.
“Our Quantum droplets are in the gas phase but they still drop like a rock,” explains experimental physicist Francesca Ferlaino when talking about the...
The Max Planck Institute for Physics (MPP) is opening up a new research field. A workshop from November 21 - 22, 2016 will mark the start of activities for an innovative axion experiment. Axions are still only purely hypothetical particles. Their detection could solve two fundamental problems in particle physics: What dark matter consists of and why it has not yet been possible to directly observe a CP violation for the strong interaction.
The “MADMAX” project is the MPP’s commitment to axion research. Axions are so far only a theoretical prediction and are difficult to detect: on the one hand,...
16.11.2016 | Event News
01.11.2016 | Event News
14.10.2016 | Event News
06.12.2016 | Materials Sciences
06.12.2016 | Medical Engineering
06.12.2016 | Power and Electrical Engineering