Sixth International Congress Drug Therapy in HIV Infection 17-21 November, 2002 Glasgow, UK

The purpose of this study is to determine whether a short course of antiretroviral therapy (SCART) in primary HIV-1 infection (PHI) is associated with induction of new viral drug resistant mutations.

PHI was defined as a negative HIV test in the previous 6 months, negative/evolving HIV antibody tests with positive HIV PCR and/or symptoms of HIV seroconversion. Patients were treated for three months or until they achieved an undetectable viral load (<50 RNA copies/ml). Initially Combivir/Nevirapine was used and, more recently, Trizivir/Efavirenz. Genotypic resistance testing was performed at baseline and at the first rebound (4 weeks) after stopping therapy.

50 patients have resistant test results from both before and after therapy. Median age (range) was 30 (21-77). Median (range) CD4 count and viral load at baseline were 475 cells/mm³ (90-1200) and 122,534 RNA copies/ml (179->500,000). 44/50 (88%) were wild type virus at baseline. 4 (8%) had single point mutations to NRTIs and only 2 patients in the cohort (4%) had acquired a multi-drug resistant virus. After stopping therapy only 2/50 had new drug resistant mutations detected. Both were treated with Combivir/Nevirapine. One developed two new mutations (K103N, M184V) having been infected with wild type virus. He was known to have been poorly adherent. The other developed the K103N and Y181C mutations as a result of slow viral suppression having been infected with multi-drug resistant virus.

SCART in PHI seems safe in terms of there being a low risk of inducing de novo drug resistant mutations as long as adherence is good and the patient is not already infected with a multi-drug resistant strain.

Presenting author: Michael Brady

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1 Imperial College, London, United Kingdom.

2002-11-17
P212

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