Treatment of primary human immunodeficiency virus type 1 infection with potent antiretroviral therapy reduces frequency of rapid progression to AIDS

Immunologic data supporting immediate antiretroviral therapy in primary hum an immunodeficiency virus type 1 (HIV-1) infection are emerging; however, c linical benefit has not been demonstrated. The clinical and virologic cours e of 47 patients who were enrolled from September 1993 through June 1996 an d who were not initially treated with potent therapy was compared with the course of 20 patients who immediately began therapy with zidovudine, lamivu dine, and indinavir. Demographic and baseline laboratory data were comparab le. During 78 weeks of follow-up, the early-treatment cohort showed a reduc ed frequency of opportunistic infections (5% vs. 21.3%; relative risk, 0.11 ; P=.02), less frequent progression to AIDS (13% vs. 0%), and significantly less frequent nonopportunistic mucocutaneous disorders and respiratory inf ections (P<.01). Plasma HIV-1 RNA levels were <50 copies/mL in all patients who continued therapy; however, after 9-12 months, HIV-1 remained detectab le in latently infected CD4(+) T cells and in lymph node mononuclear cells. Combination antiretroviral therapy during primary HIV-1 infection demonstr ated a decreased frequency of minor opportunistic infections, mucocutaneous disorders, and respiratory infections and reduced progression to AIDS.