Timely HAART initiation may pave the way for a better viral control

BMC Infectious Diseases

Research Article

Paola Paci¹  Massimo Bernaschi²  Filippo Castiglione²  Gianpiero D'Offizi³  Federico Martini³ 

[1] Biomedical University Campus, via Alvaro del Portillo 21, 00128, Rome, Italy;Institute for Computing Applications "Mauro Picone", National Research Council, Rome, 00185, Italy;National Institute for Infectious Diseases "Lazzaro Spallanzani", I.R.C.C.S., 00149, Rome, Italy;

关键词: Early Initiation;    Viral Rebound;    Nucleic Acid Sequence Base Amplification;    Therapy Interruption;    Perform Computer Simulation;   

DOI  :  10.1186/1471-2334-11-56

 received in 2010-10-25, accepted in 2011-03-01,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundWhen to initiate antiretroviral therapy in HIV infected patients is a diffcult clinical decision. Actually, it is still a matter of discussion whether early highly active antiretroviral therapy (HAART) during primary HIV infection may influence the dynamics of the viral rebound, in case of therapy interruption, and overall the main disease course.MethodsIn this article we use a computational model and clinical data to identify the role of HAART timing on the residual capability to control HIV rebound after treatment suspension. Analyses of clinical data from three groups of patients initiating HAART respectively before seroconversion (very early), during the acute phase (early) and in the chronic phase (late), evidence differences arising from the very early events of the viral infection.ResultsThe computational model allows a fine grain assessment of the impact of HAART timing on the disease outcome, from acute to chronic HIV-1 infection. Both patients' data and computer simulations reveal that HAART timing may indeed affect the HIV control capability after treatment discontinuation. In particular, we find a median time to viral rebound that is significantly longer in very early than in late patients.ConclusionsA timing threshold is identified, corresponding to approximately three weeks post-infection, after which the capability to control HIV replication is lost. Conversely, HAART initiation occurring within three weeks from the infection could allow to preserve a significant control capability. This time could be related to the global triggering of uncontrolled immune activation, affecting residual immune competence preservation and HIV reservoir establishment.

【 授权许可】

CC BY   
© Paci et al; licensee BioMed Central Ltd. 2011