Treatment during primary HIV infection does not lower viral set point but improves CD4 lymphocytes in an observational cohort.

OBJECTIVE: To investigate if early treatment of primary HIV-1 infection (PHI) reduces viral set point and/or increases CD4 lymphocytes. METHODS: Analysis of two prospective multi-centre PHI cohorts. HIV-1 RNA and CD4 lymphocytes in patients with transient treatment were compared to those in untreated patients. Time to CD4 lymphocyte decrease below 350/ microl after treatment stop or seroconversion was calculated using Kaplan-Meier and Cox-PH-regression analyses. RESULTS: 156 cases of PHI were included, of which 100 had received transient HAART (median treatment time 9.5 months) and 56 remained untreated. Median viral load (563000 cop/ml vs 240000 cop/ml; p<0.001) and median CD4 lymphocyte (449/ microl vs. 613/ microl; p<0.01) differed significantly between treated and untreated patients. Median viral load was 38056 copies/ml in treated patients (12 months after treatment stop) and 52880 copies/ml in untreated patients (12 months after seroconversion; ns). Median CD4 lymphocyte change was +60/ microl vs. -86/ microl (p = 0.01). Median time until CD4 lymphocytes decreased to <350/ microl (including all patients with CD4 lymphocytes <500/ microl during seroconversion) was 20.7 months in treated patients after treatment stop and 8.3 months in untreated patents after seroconversion (p<0.01). Cox-PH analyses adjusting for baseline VL, CD4 lymphocytes, stage of early infection and symptoms confirmed these differences. CONCLUSIONS: Treatment during PHI did not lower viral set point. However, patients treated during seroconversion had an increase in CD4 lymphocytes, whereas untreated patients experienced a decrease in CD4 lymphocytes. Time until reaching CD4 lymphocytes <350/ microl was significantly shorter in untreated than in treated patients including patients with CD4 lymphocytes <500/ microl during seroconversion.

[High incidence of non-AIDS-defined cancers among HIV-infected patients in Germany. A 3-year nationwide review]. / Hohe Inzidenz nicht AIDS-definierender Neoplasien bei HIV-infizierten Patienten in Deutschland. Ein 3-jähriger bundesweiter Uberblick.

OBJECTIVE: It was the main aim of this study to obtain data on the epidemiology of AIDS- and not AIDS-defined malignancies in HIV-positive persons, the results to provide an epidemiological overview and to be the basis for further research initiatives. Additionally it sought to gain an impression of the realities of treatment of patients with HIV-associated malignant tumors in Germany. PATIENTS AND METHODS: Over a period of 3 years (from the beginning of 2000 to the end of 2002) data were retrospectively collected on the incidence of malignant tumors in HIV-positive patients. A questionnaire was sent to all members of the German Working Party of Physicians in Private Practice Treating HIV-Infected Patients, all members of the Association of Haematologists and Oncologists in Private Practice, and all out-patient HIV clinics in Germany. The questionnaires were sent to a total of 949 practices/clinics. The data were collected on all AIDS- and not-AIDS-defined haematological malignancies and all AIDS- and not-AIDS-defined solid malignant tumors in HIV-positive patients, as well as on time of diagnosis of the malignancy, tumor stage, tumor treatment and response to treatment. RESULTS: 380 data sets on 376 patients of 50 practices/clinics were included in the analysis (four patients had two malignant tumors). 180 malignant neoplasms (47%) were AIDS-defined: 89 Kaposi's sarcomas, 82 aggressive B-cell lymphomas and 9 invasive cervical carcinomas. The aggressive B-cell lymphomas consisted of 19 cases of Burkitt's lymphoma, 8 of Castleman's disease and 12 of primary cerebral malignant lymphoma. Of the 200 (52.6%) not-AIDS-defined malignant tumors 133 were 133 solid tumors, 40 of them anal carcinoma (20% of all not-AIDS-defined malignancies) and 67 haematological malignancies, 22 of these Hodgkin's lymphoma (11.0% of all not-AIDS-defined malignancies). The incidence of anal carcinoma is estimated to be 34 (95% CI 24-470) per 100 000 patient-years, that of Hodgkin's lymphoma 19 (95% CI 12-28) per 100 000 patient-years. CONCLUSIONS: This study indicates that over a period of 3 years there was a very high incidence of not-AIDS-defined malignancies. Of special note is the high incidence of anal carcinoma and Hodgkin's lymphoma, compared with their incidence among the entire German population.