Abstract
BackgroundHIV-1 DNA persists in infected cells, forming viral reservoirs. Pre-antiretroviral treatment (ART) HIV-1 DNA load was reported to predict ART success in European severely immunocompromised patients. The aim of this study was to determine whether HIV-1 DNA levels are associated with virological success in less severely immunocompromised patients who receive early ART in sub-Saharan Africa.MethodsThe association between pre-ART HIV-1 DNA and the virological response after 30 months on ART was studied in multivariate logistic regression in patients randomised to immediate ART groups in the Temprano trial, which assessed the benefits of early ART in HIV-infected adults in Côte d’Ivoire. HIV-1 DNA was quantified in peripheral blood mononuclear cell (PBMC) using real-time PCR.ResultsHIV-1 DNA levels were measured in 1013 patients. Their medians [IQR] of pre-ART CD4 count, HIV-1 RNA and HIV-1 DNA levels were 465 [379–578]/mm3, 4.7 [4.0–5.3] log10 copies/ml and 2.9 [2.5–3.2] log10 copies/million PBMC, respectively. Pre-ART HIV-1 DNA was significantly correlated with pre-ART HIV-1 RNA (R = 0.59, p < 0.0001). In multivariate analysis, HIV-1 DNA < 3 log10 copies/million PBMC was significantly associated with virological success at M30 after adjustment for other key variables (ART regimen, IPT, sex, age, WHO clinical stage, CD4 and HIV-1 RNA; aOR 1.57; 95% CI 1.08–2.30; p = 0.02).ConclusionLow HIV-1 DNA was statistically associated with virological success in this population of sub-Saharan African adults who started treatment with a median pre-ART CD4 count at 465/mm3. HIV-1 DNA could become a useful tool for guiding some therapeutic decisions in the test-and-treat era.Trial registration TEMPRANO ANRS 12136 ClinicalTrials.gov, number NCT00495651, date of registration 03/07/2007.
Highlights
It has been widely demonstrated that HIV-1 related morbidity and mortality rates have declined dramatically since antiretroviral treatment (ART) was introduced
We looked for an association between pre-ART HIV-1 DNA levels in Peripheral Blood Mononuclear Cells (PBMC) and month 30 (M30) virologic success in HIV-infected adults who were randomised to early ART groups in the Temprano trial [1]
Of the 1033 patients included in the Immediate-ART arms, 20 (2%) were further excluded from the present analysis due to absence of a HIV-1 DNA value at baseline, and 1013 were included in the present analysis (Fig. 1)
Summary
It has been widely demonstrated that HIV-1 related morbidity and mortality rates have declined dramatically since antiretroviral treatment (ART) was introduced. Therapeutic success in people on ART and virological rebound in subjects whose treatment has failed are associated with high HIV-1 DNA levels, and are independent of the CD4 count and level of HIV-1 RNA in the plasma, as described by several previous studies [8,9,10,11]. These studies, were mainly carried out in industrialised countries in severely immunocompromised patients. The aim of this study was to determine whether HIV-1 DNA levels are associated with virological success in less severely immuno‐ compromised patients who receive early ART in sub-Saharan Africa
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