Journal Article

Early ART Sustains Telomere Length in Newly Diagnosed HIV

BOTTOM LINE

Telomere length decreases with age. Also, there is shortening of telomere length associated with HIV infection.  This study addresses the question as to whether immediate treatment for new HIV diagnosis can reduce telomere shortening.

In 105 participants (median age of 36 years) the median ART initiation time was divided into 25, 42, and 60-day groupings by date of diagnosis date and followed over a 6-year period.  Telomere length was measured in stored peripheral blood mononuclear cells from available specimens over the same period. With comparison of groupings those with treatment initiated at 25 days had the longest telomere lengths both when diagnosed and over the 6-year period.  These findings suggested the need for the earliest ART possible for those diagnosed with HIV to maintain telomere length, or mitigate telomere shortening. This may provide a better understanding of aging in the older adult living with HIV

ABSTRACT

Background

Telomere length (TL) shortens during aging, HIV seroconversion, and untreated chronic HIV infection. It is unknown whether early antiretroviral therapy (ART) start is associated with less TL shortening during primary HIV infection (PHI).

Methods

We measured TL in peripheral blood mononuclear cells by quantitative polymerase chain reaction in participants of the Zurich PHI Study with samples available for ≥6 years. We obtained univariable/multivariable estimates from mixed-effects models and evaluated the association of delaying ART start or interrupting ART with baseline and longitudinal TL.

Results

In 105 participants with PHI (median age 36 years, 9% women), median ART delay was 25, 42, and 60 days, respectively, in the first (shortest), second, and third (longest) ART delay tertile. First ART delay tertile was associated with longer baseline TL (P for trend = .034), and longer TL over 6 years, but only with continuous ART (P < .001), not if ART was interrupted ≥12 months (P = .408). In multivariable analysis, participants in the second and third ART delay tertile had 17.6% (5.4%–29.7%; P = .004) and 21.5% (9.4%–33.5%; P < .001) shorter TL, after adjustment for age, with limited effect modification by clinical variables.

Conclusions

In PHI, delaying ART start for even a matter of weeks was associated with significant and sustained TL shortening.

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