Markers of HIV reservoir size and immune activation after treatment in acute HIV infection with and without raltegravir and maraviroc intensification

Background It is unclear whether intensification of standard highly active antiretroviral therapy (HAART) with entry and integrase inhibitors during acute HIV infection (AHI) could yield greater benefits in reducing markers for HIV reservoir size and immune activation. Methods Thai patients with Fiebig I–IV AHI were prospectively enrolled and offered treatment. They were randomised 1 : 1 to HAART (tenofovir/emtricitabine/efavirenz, n=31) or megaHAART, a standard regimen intensified by raltegravir/maraviroc (n=31), during the first 24 weeks of therapy. Participants were monitored at weeks 0, 2, 4, 8 and 12, then every 12 weeks. Frequencies of peripheral blood mononuclear cells (PBMCs) carrying HIV DNA (total, integrated and 2-LTR episomes), plasma C-reactive protein (CRP) concentrations, and frequencies of activated T cells were measured. Flexible sigmoidoscopy was performed in willing participants (n=25) at baseline, weeks 24 and 96, and proviral DNA and RNA were determined. Results Baseline characteristics were similar in the HAART and megaHAART arms. Median age was 28 years and 95% were men. Median CD4 cell count was 388 cells/mm3. HIV RNA was 5.6 log10 copies/mL. HIV RNA declined more rapidly in the first 4 weeks with megaHAART (median –3.3 log10) than HAART (–2.6 log10). Time to achieve HIV RNA