7th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013)

Abstract

TUPE252 - Poster Exhibition


A novel acute retroviral syndrome severity score predicts surrogate markers associated with HIV-1 disease progression

D.L. Braun, R. Kouyos, C. Grube, B. Joos, H. Kuster, B. Ledergerber, H. Günthard, Zurich Primary HIV Infection Study Group

University Hospital Zurich, University of Zurich, Division of Infectious Diseases and Hospital Epidemiology, Zurich, Switzerland

Background: Best practice in primary HIV-1 infection (PHI) remains unknown. A risk-based scoring system could be helpful to stratify patients benefiting from early antiretroviral treatment (eART). Here we analyzed our newly developed “Acute Retroviral Syndrome Severity Score” (ARSSS) in relation to the surrogate markers associated with PHI disease progression.
Methods: We longitudinally enrolled 280 individuals with a documented PHI in our Zurich Primary HIV-Infection Study, an open label, non-randomized, observational, monocenter study. For each patient we calculated an ARSSS including the following parameters a) severe neurological symptoms (e.g. aseptic meningitis, encephalitis), 3 points; b) inpatient treatment, 3 points; c) age ≥ 50 years, 1 point; d) fever (≥ 38°C), 1 point; e) sexual transmitted infection; 1 point f) elevated liver enzymes (ASAT/ALAT > 35 U/l), 1 point; g) thrombocytopenia (< 150 G/l), 1 point. We used linear regression models to assess the impact of ARSSS on log baseline virus load (VL), baseline CD4 count and viral setpoint (sVL) (i.e. VL measured at least 60 days after the estimated time of infection [ETI] and treatment interruption).
Results: Median ARSSS was 2.3 (range 0 to 11). Individuals with a high ARSSS had at baseline a significantly lower CD4 count (p=0.01, n=267) and higher HIV-RNA levels (p=0.000, n=270). In the regression model, a difference of one calculated scoring point corresponded with a 0.12 log increase in baseline VL and a CD4-cell decline of 15/ul. Treatment naïve individuals with a high ARSSS had a significantly higher sVL (p=0.008, n=97). We found no significant correlation with the level of the sVL in patients with eART after controlled treatment interruption (p=0.46, n=44).


ARSSS_graphic
[ARSSS_graphic]


Conclusion: Our novel ARSSS can be used to identify patients with PHI with the highest risk for clinical disease progression. Patients with a high ARSSS should strongly be considered for immediate antiretroviral treatment.

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