In the first study, Dr. Radjin Steingrover from the University of Amsterdam reported his group's findings for 332 patients with laboratory evidence of primary HIV-1 infection. Sixty-four started highly active antiretroviral therapy within 180 days of seroconversion. Thirty-two of these patients subsequently stopped treatment. The remaining patients delayed treatment.

A viral set-point was reached 7 weeks after seroconversion or interruption of treatment. Compared with the untreated patients, the viral set-point was 0.6 log copies/mL lower in those who interrupted early treatment (p < 0.001), Dr. Steingrover reported.

This lowering of viral set-point following early treatment, he concluded, "indicates there are long-term clinical benefits to be gained" from this treatment strategy. No differences in CD4 cell counts were seen between the early and delayed treatment groups.

Symptoms during primary infection were also not associated with increased time to AIDS or death.

A factor that biased the results, Dr. Steingrover added, was that primary infection patients with high viral loads, known to be associated with a poor prognosis, were more likely to receive early treatment.

When asked how he would manage patients with primary infection, he said patients presenting with severe symptoms, requiring hospitalization, should probably start treatment immediately, whereas those with mild or no symptoms can probably wait until changes in HIV-1 load and CD4 counts begin.

Contradictory results were obtained in the second study, in which early treatment appeared to have no effect on viral set-point. However, a beneficial effect on CD4 cell counts was noted.

Using a different approach, Dr. Christine Koegl of MUC, Munich, and colleagues are following 200 patients with primary HIV-1 infection enrolled in one of two large ongoing trials. One hundred forty-four subjects began treatment immediately and 56 delayed treatment. So far, the team has followed the patients for a median of 27 months, Dr. Koegl said.

When 100 patients stopped therapy after 9.5 months, viral load was below detection in 82% and the median CD4 count was 799 cells per microliter.

However, 12 months after treatment was stopped, the median viral load was up to 38,056 copies/mL compared with 52,880 copies/mL in the untreated patients. Median CD4 values were 538 cells per microliter in patients who had been treated compared with 525 cells per microliter in the untreated group.

"On the other hand, we have three patients (in the early treatment group) who are still undetectable," Dr. Koegl said. These patients appear to have benefited from early treatment, "but we don't know why," she added.

Overall, Dr. Koegl concludes that early treatment has no significant effect on viral load 12 months after treatment is stopped. However, compared with baseline values, the untreated patients had a median decline in CD4 count of 87 cells per microliter, whereas the treated patients had an increase of 60 cells per microliter, suggesting a beneficial immunologic effect.

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