Should ART be initiated during primary infection?



366 patients with HIV seroconversion within 6 months were randomised to three arms; No treatment, 12 weeks of ART and 48 weeks of ART. The primary endpoints were CD4 decline to less than 350 or initiation of long term ART. Median follow up time was 4.2 years. The primary endpoint was reached in 61, 61 and 50% in the three arms. In the 48 weeks treatment arm the median time to the primary endpoint was 65 weeks longer than in the arm without treatment and in the 12 weeks ART arm the difference was 27 weeks.

The SPARTAC Trial Investigators. Short-course antiretroviral therapy in primary HIV infection. N Engl J Med. 2012;368:207-17.

Comment: The delay until the primary endpoint with treatment compared to no treatment is slightly longer than the duration of treatment. This rather small difference is probably of minor clinical importance. The reasonable approach is continuous therapy once ART is initiated and perhaps all patients with primary infection or recent seroconversion should be offered ART?