RESUMO
Aggressive treatment has been advocated for the management of primary HIV infection (PHI), but the composition and the optimal duration of therapy are still to be determined. In addition, time to undetectable viral load (VL), rate and duration of VL suppression as well as subsequent therapeutic choices remain issues widely debated. We evaluated the rate and duration of VL suppression in 12 consecutive patients with PHI given triple-drug treatment with zidovudine, lamivudine and indinavir (highly active antiretroviral therapy, HAART) at onset of the acute illness and subsequently switched to a simplified 2-NRTI-based regimen once VL suppression was maintained for at least 6 months. Throughout the study, no patient discontinued treatment because of symptoms attributed to the study medications. In the study population, undetectable VL was achieved after a median of 84 days (range: 67-135) on HAART and was maintained for a median of 194 days (range: 179-205) before simplification. After switching to simplified maintenace, undetectable VL was maintained in all patients for at least 6 months. Only one patient experienced virological failure, plasma HIV-RNA remaining suppressed for a median foliow-up of 33 months (15-54) and T-CD4+ being steadily higher than 500/mL in the remaining patients. Our results suggest that simplification of HAART in patients promptly treated during PHI and maintaining undetectable VL for at least 6 months before simplification may be a valid option capable of controlling viral replication and maintaining an optimal immunological profile for a prolonged time.
Assuntos
Fármacos Anti-HIV/administração & dosagem , Terapia Antirretroviral de Alta Atividade , Infecções por HIV/tratamento farmacológico , HIV-1 , Viremia/tratamento farmacológico , Adulto , Contagem de Linfócito CD4 , Esquema de Medicação , Combinação de Medicamentos , Feminino , Seguimentos , Inibidores da Protease de HIV/administração & dosagem , HIV-1/efeitos dos fármacos , HIV-1/isolamento & purificação , HIV-1/fisiologia , Humanos , Indinavir/administração & dosagem , Lamivudina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , RNA Viral/sangue , Inibidores da Transcriptase Reversa/administração & dosagem , Resultado do Tratamento , Carga Viral , Replicação Viral/efeitos dos fármacos , Zidovudina/administração & dosagemRESUMO
The authors describe a case of severe CMV retinitis in a young adult AIDS patient who recovered following first a course of ganciclovir and then HAART. Six months after the initial episode while still under successful HAART, the patient developed an acute episode of retinitis despite a persistent significant improvement in the immunological picture and a very low level of CMV reactivation. The acute episode can be related to an enhanced individual reactivity to minor CMV replication.