Effectiveness of Antiretroviral Therapy During Acute HIV Infection

Antiretroviral (ARV) therapy for the treatment of HIV infection has been remarkably
successful in reducing morbidity and mortality in HIV infected people. This treatment still
has its shortcomings, however. Individuals receiving ARV treatment are at risk of toxicity,
developing drug resistance, and unknown long-term side effects. Therefore, development of
alternative treatment strategies is important. A short course of ARV treatment that is
initiated during the acute period of HIV infection, followed by treatment cessation may have
a substantial impact on controlling infection and delaying the need for lifelong potent ARV
therapy. The purpose of this study is to investigate whether treatment initiated during acute
HIV infection and followed by a terminal treatment interruption is effective in lowering the
viral load set point and raising CD4 cell counts in people with HIV, as compared to those
measures in people with HIV who have received no treatment.

Participants in this study will be randomly assigned to one of three groups. Participants in
Group A1 will receive ARV therapy for 12 weeks. Participants in Group A2 will receive ARV
therapy for 32 weeks. Participants in Group B will not receive any treatment. This study will
not provide medications to any of the groups. All groups will be followed for a total of 72
weeks following study entry. Participants will attend between 30 and 36 study visits over the
course of the 72 weeks, depending on their study group. Study visits will occur every week
for the first 12 weeks and then every 1 to 6 weeks for the remainder of the study. Tests
occurring at study visits may include blood tests, investigational immune system tests, and
pregnancy tests. Participants will also undergo a complete physical exam and will be asked to
provide information about their medical and medication histories.

Inclusion Criteria:

- Acute HIV infection as determined by a positive HIV viral load (at least 5,000 copies
of RNA per ml of plasma) and a negative or indeterminate Western Blot test

- Certain laboratory values. More information about this criterion can be found in the
protocol.

- Agrees to use an approved form of contraception

Exclusion Criteria:

- Presence of opportunistic infections or AIDS-defining illnesses, unless they are
directly attributable to the acute seroconversion illness

- Receipt of investigational research agents within 30 days prior to study entry

- Receipt of prior experimental HIV vaccines. Individuals who received a saline placebo
in a prior HIV vaccine trial are not excluded, provided that they did not receive a
sham vector or an adjuvant.

- Receipt of immunosuppressive medications or immunomodulators (e.g., cytokine therapy)
within the past 6 months. Participants taking corticosteroid nasal spray for allergic
rhinitis; topical corticosteroids for acute, uncomplicated dermatitis; or over the
counter medications for acute, uncomplicated dermatitis for a period not longer than
14 days will not be excluded.

- Current use of prohibited concomitant medications

- Current anti-tuberculosis prophylaxis or therapy

- Serious illness other than acute HIV infection requiring systemic treatment or
hospitalization until either therapy is completed or patient is clinically stable on
therapy

- Hepatitis B surface antigen positivity within 21 days prior to study entry

- Pregnant or breastfeeding