Abstract
BackgroundThe effect of ART initiation time on HIV-1 DNA reservoir in chronically infected individuals is not well understood. Determining the potential influencing factors associated with a low HIV-1 DNA level in chronic infection is an important step toward drug-free control.MethodsA prospective study included 444 chronically HIV-infected adults was performed. Participants were divided into two groups: early initiation group (EIG) or delayed initiation group (DIG) based on their baseline CD4 count; 350 to 500 and < 350 cells/mm3, respectively. Total HIV-1 DNA was measured by quantitative PCR. Using the Mann-Whitney U test, the HIV-1 DNA level at week 48 was compared between the two groups. The influencing factors of the HIV-1 DNA and factors associated with achieving a low HIV-1 level at week 48 were analyzed.ResultsThe HIV-1 DNA at week 48 in EIG was significantly lower than in DIG [2.12 (1.80–2.51) vs 2.58 (2.21–2.87) log10 copies/106peripheral blood mononuclear cells (PBMCs); p = 0.001]. Early ART initiation was positively associated with lower HIV-1 DNA at week 48 (p = 0.025). Similarly, baseline HIV-1DNA (p = 0.001) was positively associated with HIV-1DNA at week 48 and baseline CD4/CD8 ratio (p = 0.001) was inversely associated with HIV-1DNA at week 48. Early ART initiation (p = 0.003) and baseline HIV-1 DNA level (p < 0.001) were positively associated with achieving HIV-1 DNA < 100 copies/106 PBMCs at week 48.ConclusionEarly ART initiation is positively associated with a smaller size of viral reservoir and a higher possibility of achieving a low HIV-1DNA level at week 48 in Chinese chronically HIV-1 infected adult.Trial registrationNCT01844297; Registered 1 May, 2013.
Highlights
The effect of antiretroviral treatment (ART) initiation time on Human immunodeficiency virus (HIV)-1 DNA reservoir in chronically infected individuals is not well understood
Effects of ART initiation time on the HIV-1 DNA at week 48 We examined how the HIV-1 DNA at week 48 was influenced by ART initiation time (EIG vs. delayed initiation group (DIG)), age, sex, the baseline CD4 count, the baseline CD4/CD8 ratio, the baseline HIV-1 RNA and the baseline HIV-1 DNA
Considering that a low HIV-1 DNA level is meaningful for functional cure, our study may contribute to the selection and the monitoring of patients on ART who will be selected to participate in eradication studies [29]
Summary
The effect of ART initiation time on HIV-1 DNA reservoir in chronically infected individuals is not well understood. Determining the potential influencing factors associated with a low HIV-1 DNA level in chronic infection is an important step toward drug-free control. Very low HIV-1 DNA are observed in 2 particular populations of HIV-infected individuals: the elite HIV controllers Reducing the HIV-1 DNA reservoir as much as possible can be an interesting aim, as it could be a criterion for ART reduction or interruption [8]. HIV-1 DNA level is considered to be associated with non-AIDS related morbidities [9] and mortalities in virally suppressed patient [10]
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