Early Initiation of ART in Acute HIV Infection May Protect the CNS

Initiating antiretroviral therapy (ART) early in patients with acute HIV infection (AHI) may normalize cerebrospinal fluid (CSF) levels after only 24 weeks of treatment, according to a new study. However, blood plasma may remain elevated.

“These findings lend further evidence for the protective effects of early ART initiation on the [central nervous system] and therefore provide strong support for prompt initiation of ART,” the study authors wrote.

To reach this conclusion, the researchers examined immune activation markers of participants from the RV254/SEARCH010 study who had AHI. In all, 89 participants underwent CSF sampling and 146 underwent plasma sampling. The researchers collected the samples before ART initiation and then again at weeks 24 and 96. 

IF YOU LIKE THIS, READ MORE...

4 Questions About How Chlamydia trachomatis Infection Affects Reproductive Health Outcomes

Injectable PrEP Options May Help Reach Racial Minority MSM

The median estimated infection duration at study entry was 17 days (range, 4 to 48 days). Overall, 64.4% of the participants received a standard ART regimen, 34.7% of whom also received maraviroc and raltegravir for the first 24 weeks (ART-plus). 

The researchers compared the participants’ neopterin, CXCL10, CCL2, and interleukin 6 levels with those of 18 healthy, uninfected controls. After this analysis, the researchers found that the levels of all CSF markers in the participants with AHI had normalized after 24 and 96 weeks of treatment, returning to levels seen among the control group. 

However, levels of several plasma markers remained elevated among participants with AHI, with participants who had been receiving the ART-plus regimen having lower median plasma CCL2 levels at week 24 and lower plasma neopterin levels at week 96.

“ART initiation during AHI differentially impacts the brain compartment, with markers of inflammation returning to normal levels in the CSF, where they were sustained at week 96, but not in plasma,” the researchers concluded.

—Colleen Murphy

Reference:

Hellmuth J, Slike BM, Sacdalan C, et al; SEARCH 010/RV254 and SEARCH013/RV304 study groups. Very early initiation of antiretroviral therapy during acute HIV infection is associated with normalized levels of immune activation markers in cerebrospinal fluid but not in plasma. J Infect Dis. 2019;220(12):1885-1891. https://doi.org/10.1093/infdis/jiz030.