Greater reversal of CD4+ cell abnormalities and viral load reduction after initiation of antiretroviral therapy with zidovudine, lamivudine, and nelfinavir before complete HIV type 1 seroconversion

• Published in: AIDS research and human retroviruses Vol. 19; no. 3; p. 189
• Main Authors: Smith, Don E, Kaufmann, Gilbert R, Kahn, James O, Hecht, Frederick M, Grey, Patricia A, Zaunders, John J, Cunningham, Philip H, Carr, Andrew, Duncombe, Christopher, Quan, Dick C, Petersen, Annkatrin, Cooper, David A
• Format: Journal Article
• Language: English
• Published: United States 01-03-2003
• Subjects: Anti-HIV Agents - adverse effects; Anti-HIV Agents - therapeutic use; Antiretroviral Therapy, Highly Active; CD4 Lymphocyte Count; HIV Infections - drug therapy; HIV Infections - virology; HIV Seropositivity; HIV-1 - drug effects; HIV-1 - physiology; Humans; Lamivudine - adverse effects; Lamivudine - therapeutic use; Male; Nelfinavir - adverse effects; Nelfinavir - therapeutic use; Prospective Studies; RNA, Viral - blood; Viral Load; Zidovudine - adverse effects; Zidovudine - therapeutic use
• ISSN: 0889-2229
• DOI: 10.1089/088922203763315696

In a prospective open-label study, 41 male subjects received nelfinavir, zidovudine, and lamivudine stratified as either: early stage (ES; negative/indeterminate Western blot; n = 19) or late stage (LS; positive Western blot; n = 22) primary HIV-1 infection. Despite higher median baseline HIV-1 RNA levels and lower CD4(+) cell numbers in the ES subjects, a significantly greater decline in viral load (-3.46 vs. -2.83 log(10) copies/ml; p = 0.023) and increase in CD4(+) cell number (+85 vs. +41 cells/month increase, p = 0.01) were observed over the first 3 months of therapy such that both groups had comparable results at 1 year. The proportion with HIV-1 RNA < 50 copies/mL at 1 year was similar (9 of 19 ES subjects and 11 of 22 LS subjects by intention-to-treat analysis). Memory CD4(+) cell numbers, and activated CD4(+) percentages, were also significantly improved in ES subjects. Despite poorer prognostic markers at baseline ES subjects achieved responses similar to those of LS subjects after 1 year of treatment.