The effect of commencing combination antiretroviral therapy soon after human immunodeficiency virus type 1 infection on viral replication and antiviral immune responses

Twelve subjects were treated with zidovudine, lamivudine, and ritonavir wit hin 90 days of onset of symptoms of acute infection to determine whether hu man immunodeficiency virus type 1 (HIV-1) infection could be eradicated fro m an infected host. In adherent subjects, with or without modifications due to intolerance, viral replication was suppressed during the 24-month treat ment period. Durable suppression reduced levels of HIV-1-specific antibodie s and cytotoxic T lymphocyte responses in selected subjects. Proviral DNA i n mononuclear cells uniformly persisted. The persistence of HIV-1 RNA expre ssion in lymphoid tissues and peripheral blood mononuclear cells suggests t hat elimination of this residual pool of virus should be achieved before co nsidering adjustments in antiretroviral therapeutic regimens. In addition, given the reduction in levels of virus-specific immune responses, it would seem prudent to consider enhancing these responses using vaccine strategies prior to the withdrawal of antiviral therapy.