Successful Viral Suppression Research Articles

Clinical Profile and Adverse Effects of Dolutegravir Treatment in HIV-Positive Patients: A Prospective Observational Study.

Background The emergence of dolutegravir (DTG) within antiretroviral therapy (ART) has drastically improved the management of HIV/AIDS, marking a shift towarda chronic manageable condition. Nevertheless, concerns persist regarding the real-world tolerability and adverse effects (AEs) of DTG. Objective This study aims to explore the clinical characteristics, adverse reactions, and adherence to treatment with DTG among HIV-positive individuals. Methods Through a prospective approach, we examined HIV-positive patients undergoing DTG-based ART regimens. Key parameters, including socio-demographic data, treatment adherence, and clusters of differentiation 4 (CD4) count, were evaluated. Enrolled patients were followed up for six months for the development of comorbidities and AEs. Results Initial observations indicate successful viral suppression and enhanced CD4 counts with DTG-based regimens, t(318)=2.0664, p=0.0392. However, a subset of participants experienced AEs such as neuropsychiatric symptoms (headaches and mood fluctuations), unintended weight gain, and other comorbidities linked to prolonged ART usage. Conclusion While DTG-based therapies offer substantial advantages in HIV/AIDS management, such as rapid viral suppression and reduced toxicity, ongoing vigilance for adverse effects, particularly neuropsychiatric symptoms and metabolic disturbances, is imperative for optimizing patient care. Further research is necessary to fully elucidate the safety profile of DTG in real-world scenarios and mitigate potential adverse reactions.

Early Initiation of Antiretroviral Therapy is Protective Against Seizures in Children With HIV in Zambia: A Prospective Case-Control Study.

Seizures are relatively common among children with HIV in low- and middle-income countries and are associated with significant morbidity and mortality. Early treatment with antiretroviral therapy (ART) may reduce this risk by decreasing rates of central nervous system infections and HIV encephalopathy. We conducted a prospective, unmatched case-control study. We enrolled children with new-onset seizure from University Teaching Hospital in Lusaka, Zambia and 2 regional hospitals in rural Zambia. Controls were children with HIV and no history of seizures. Recruitment took place from 2016 to 2019. Early treatment was defined as initiation of ART before 12 months of age, at a CD4 percentage >15% in children aged 12-60 months or a CD4 count >350 cells/mm 3 for children aged 60 months or older. Logistic regression models were used to evaluate the association between potential risk factors and seizures. We identified 73 children with new-onset seizure and compared them with 254 control children with HIV but no seizures. Early treatment with ART was associated with a significant reduction in the odds of seizures [odds ratio (OR) 0.04, 95% confidence interval: 0.02 to 0.09; P < 0.001]. Having an undetectable viral load at the time of enrollment was strongly protective against seizures (OR 0.03, P < 0.001), whereas history of World Health Organization Stage 4 disease (OR 2.2, P = 0.05) or CD4 count <200 cells/mm 3 (OR 3.6, P < 0.001) increased risk of seizures. Early initiation of ART and successful viral suppression would likely reduce much of the excess seizure burden in children with HIV.

Factors associated with viral load testing and viral suppression among HIV-positive female sex workers in Nigeria.

Female sex workers (FSWs) are at high risk for HIV infection and face unique barriers to receiving and adhering to testing and treatment. Early viral suppression and consistent viral load testing are critical to optimizing health and reducing transmission in this population. However, the factors associated with testing and successful viral suppression among FSWs are poorly understood, especially in Sub-Saharan Africa. Our study aimed to examine factors, including social, demographic, and clinical characteristics, associated with viral load testing and suppression among female sex workers initiating antiretroviral therapy in Nigeria. In this retrospective study, we analyzed routine programmatic data from FSWs enrolled in the National HIV Key Populations (KP) program in Nigeria. We included FSWs who were newly diagnosed with HIV and registered between January 2016 and January 2022. Primary outcomes of interest were a), receiving a viral load test at any point after treatment initiation and b), viral suppression (<1000 copies/ml) at the test closest to 6 months after treatment initiation. To identify factors associated with the outcomes of interest, we used univariable and multivariable logistic regression, with random intercepts for care facilities, and multiple imputation for missing values. Out of 34,976 FSWs, 97.1% (n = 33,945) received at least one viral load test, with 94.5% (n = 32,092) indicating viral suppression. The odds of receiving at least one viral load test were higher for those who entered treatment in more recent years, those with formal education and those with advanced HIV stages at baseline (adjusted odds ratios [aOR]: 1.17 [1.14-1.19] for those who entered treatment in 2020 vs. 2016; 1.02 [1.01-1.03] for post-secondary vs. no education; and 1.05 [1.01-1.10] for WHO clinical stage 3/4 vs. stage 1 respectively). The odds of successful viral suppression were higher for those who entered treatment in more recent years, but lower for those with advanced HIV stages at baseline (aOR: 1.13 [1.09-1.18] for 2022 vs. 2016; and 0.92 [0.87-0.98] for WHO clinical stage 3/4 vs. stage 1 respectively). The study underscored the relevance of timely diagnosis and ART initiation for optimal outcomes among HIV-positive FSWs in Nigeria. We also observed significant improvements in the likelihood of early viral load testing and suppression over the study period, reflecting advancements in the KP program. Further research should clarify factors driving these trends to further strengthen the HIV care pipeline for female sex workers.

Poor Prognosis in HBV-associated Hepatocellular Carcinoma After Successful Viral Suppression: A Case Series Highlighting a Need for a Cure

Hepatocellular Carcinoma (HCC) is one of the leading causes of cancer-related deaths worldwide, with chronic hepatitis B virus (HBV) infection being an important risk factor for HCC. While nucleos(t)ide analog (NA) therapy has succeeded in suppressing HBV replication and decreasing the risk of HCC in patients with HBV infection, there remains a persistent risk of HCC in those patients. Furthermore, previous studies have highlighted worse survival in patients who developed HCC while on successful NA therapy compared to those who developed HCC without previous NA treatment. We conducted a long-term, retrospective case study in 5 patients observed between 10 and 25 years, to further explore the poor outcomes in patients with HBV-associated HCC with or without previous NA therapy. Our study highlights the aggression and recurrence of HCC in patients with HBV infection, well-suppressed on NA therapy. The results of our observation emphasize the need for early referral for liver transplantation in these select patients.

Navigating the complexity of chronic HIV-1 associated immune dysregulation.

Despite successful viral suppression with antiretroviral therapy, chronic HIV-1 infection is associated with ongoing immune dysfunction. Investigation of the complex immune response in treated and untreated individuals with chronic HIV-1 infection is warranted. Immune alterations such as monocyte phenotype and Th-17/Treg ratios often persist years after the reduction in viraemia and predispose many individuals to long-term comorbidities such as cardiovascular disease or cancer. Furthermore, while there has been extensive research on the latent reservoir of treated patients with chronic HIV-1, which prevents the discontinuation of treatment, the mechanism behind this remains elusive and needs further investigation. In this review, we assist in navigating the recent research on these groups of individuals and provide a basis for further investigation.

Liver Bacterial Dysbiosis With Non-Tuberculosis Mycobacteria Occurs in SIV-Infected Macaques and Persists During Antiretroviral Therapy.

Liver disease is a significant contributor to morbidity and mortality in HIV-infected individuals, even during successful viral suppression with combination antiretroviral therapy (cART). Similar to HIV infection, SIV infection of rhesus macaques is associated with gut microbiome dysbiosis and microbial translocation that can be detected systemically in the blood. As microbes leaving the intestines must first pass through the liver via the portal vein, we evaluated the livers of both SIV-infected (SIV+) and SIV-infected cART treated (SIV+cART) rhesus macaques for evidence of microbial changes compared to uninfected macaques. Dysbiosis was observed in both the SIV+ and SIV+cART macaques, encompassing changes in the relative abundance of several genera, including a reduction in the levels of Lactobacillus and Staphylococcus. Most strikingly, we found an increase in the relative abundance and absolute quantity of bacteria within the Mycobacterium genus in both SIV+ and SIV+cART macaques. Multi-gene sequencing identified a species of atypical mycobacteria similar to the opportunistic pathogen M. smegmatis. Phosphatidyl inositol lipoarabinomannan (PILAM) (a glycolipid cell wall component found in atypical mycobacteria) stimulation in primary human hepatocytes resulted in an upregulation of inflammatory transcriptional responses, including an increase in the chemokines associated with neutrophil recruitment (CXCL1, CXCL5, and CXCL6). These studies provide key insights into SIV associated changes in hepatic microbial composition and indicate a link between microbial components and immune cell recruitment in SIV+ and SIV+cART treated macaques.

Quantification of CD4 Recovery in Early-Treated Infants Living With HIV.

Perinatally HIV-acquired infants benefit from an early antiretroviral treatment initiation. Thanks to a short viral exposure time, their immune system can be maintained or reconstituted, allowing a "normal" immune development. In this study, we mathematically modeled and quantified individual CD4+ T-cell reconstitution of a subset of 276 children who started treatment within 6 months of age and achieved sustained viral suppression. Considering natural age differences in CD4+ T-cell dynamics, we fitted distances to age-matched healthy reference values with a linear model approaching an asymptote. Depleted CD4+ percentages (CD4%) and CD4+ counts (CD4ct) restored healthy levels during treatment. CD4ct recovered with a median rate of 4 cells/µL/d, and individual recovery rates were correlated negatively with their initial CD4ct. CD4 values at onset of treatment decrease with age, whereas recovery times and levels seem to be age-independent. CD4 recovery correlates positively with viral suppression, and the stabilization of CD4 levels usually occurs after viral suppression. CD4 levels stabilize within 3-13 months after treatment initiation. The recovery dynamics of the CD4% is comparable with those of the CD4ct. In early-treated children with successful viral suppression, the CD4 depletion is typically mild and CD4+ T cells tend to "fully" recover in numbers.

The effect of age on CD4+ T-cell recovery in HIV-suppressed adult participants: a sub-study from AIDS Clinical Trial Group (ACTG) A5321 and the Bone Loss and Immune Reconstitution (BLIR) study

Older age could be a risk factor for suboptimal CD4+ T-cell recovery in HIV-infected patients despite successful viral suppression. However, evaluation of this effect could be confounded by age-related immune processes such as decreased thymus output, increased immune activation and exhaustion. Here, we established a semi-mechanistic population model simultaneously describing naïve and memory CD4+ T-cell trajectories in 122 participants. Covariate analysis accounting for immune activation showed that older age was significantly associated with faster apparent elimination rate of the naïve T-cells. In addition, female sex predicted slower apparent elimination rate of memory T-cells. Simulations showed that the median maximal CD4+ T-cell count on ART treatment was 593 cells/μL (IQR 442-794) in patients aged 50 years or above and 738 cells/μL (IQR 548-1002) in patients aged 18-35 years. The differences in the percentage of subjects achieving sufficient immune reconstitution (CD4+ T-cell count> 500 cells/μL) between the two age groups were 15, 21 and 26% at year 1, 4 years and steady state, respectively, suggesting that advanced age may have a greater impact on long-term CD4+ T-cell recovery.

A Qualitative Study to Identify the Perceptions of Adherence to Antiretroviral Therapy among People Living with HIV.

Background:Primary health care for marginalized population group such as people living with HIV (PLHIV) is challenging as evidenced by the alarming magnitude of nonadherence to freely available antiretroviral therapy (ART). Successful viral suppression depends on optimum adherence to ART which in turn depends on the client's perceptions toward adherence and ART.Objectives:This study aims at identifying the prevailing perceptions of PLHIV toward adherence to ART.Materials and Methods:A qualitative research was conducted through 7 focused group interviews and 5 in-depth interviews among 44 PLHIV across 3 ART centers of different organizational characteristics. Interviews were transcribed and analyzed through a thematic content analysis approach. Unique perceptions and thoughts identified from each interview were listed and regrouped according to related themes. Data were triangulated across different sources of information such as key informant interview and review of the literature.Results:The median age of PLHIV was 36 years, and the mean duration of ART was 3.53 years. A qualitative analysis of transcribed data yielded stigma, cost, distance, type of health-care setting, and desire for living longer as dominant themes in perceptions of PLHIV toward ART.Conclusion:Overall 70% of perceptual expressions and 15 themes out of 30 themes were related to person related factors that determine the adherence to ART.

Clinical and Virological Outcomes of TB/HIV Coinfected Patients Treated With Dolutegravir-Based HIV Antiretroviral Regimens: Programmatic Experience From Botswana.

Dolutegravir (DTG) has recently been recommended as a preferred first-line regimen for the treatment of new and treatment-experienced HIV-infected patients. However, potential drug interactions between DTG and rifampicin remain a clinical and public health concern. We analyzed HIV and Tuberculosis (TB) treatment outcomes of HIV-infected patients concomitantly receiving rifampicin- and DTG-based regimens under programmatic conditions in Botswana. The outcomes of interest were successful TB treatment and viral load suppression. We used multivariable logistic models to determine predictors for each outcome of interest. A total of 1225 patients were included in the analysis to evaluate predictors of successful TB outcome. Among patients on DTG and non-DTG regimens, 90.9% and 88.3% achieved favorable TB treatment outcomes, respectively. Of those who received DTG-based regimen; 44% received once-daily dosing and 53% twice-daily dosing. We found that DTG was associated with favorable TB treatment outcome (adjusted odds ratio = 1.56; 95% confidence interval = 1.06 to 2.31), after adjusting for age, gender, and CD4 cell counts. High rates of viral load suppression were found across all antiretroviral therapy (ART) regimen categories (>92% for all). We did not find an independent association between DTG and viral suppression after adjustment of other covariates. The use of DTG-based ART regimens in patients coinfected with TB and HIV lead to favorable TB and HIV treatment outcomes, comparable to those achieved with alternative ART regimens. Our results provide reassurance to TB and HIV programs about the overall programmatic concomitant use of these first-line treatment regimens for the management of HIV and TB coinfected patients.

Progressive brain atrophy in chronically infected and treated HIV+ individuals.

Growing evidence points to persistent neurological injury in chronic HIV infection. It remains unclear whether chronically HIV-infected individuals on combined antiretroviral therapy (cART) develop progressive brain injury and impaired neurocognitive function despite successful viral suppression and immunological restoration. In a longitudinal neuroimaging study for the HIV Neuroimaging Consortium (HIVNC), we used tensor-based morphometry tomap the annual rate of change of regional brain volumes (mean time interval 1.0± 0.5 yrs), in 155 chronically infected and treated HIV+ participants (mean age 48.0 ± 8.9years; 83.9% male) . We tested for associations between rates of brain tissue loss and clinical measures of infection severity (nadir or baseline CD4+ cell count and baseline HIV plasma RNA concentration), HIV duration, cART CNS penetration-effectiveness scores, age, as well as change in AIDS Dementia Complex stage. We found significant brain tissue loss across HIV+ participants, including those neuro-asymptomatic with undetectable viral loads, largely localized to subcortical regions. Measures of disease severity, age, and neurocognitive decline were associated with greater atrophy. Chronically HIV-infected and treated individuals may undergo progressive brain tissue lossdespite stable and effective cART, which may contribute to neurocognitive decline. Understanding neurological complications of chronic infection and identifying factors associated with atrophy may help inform strategies to maintain brain health in people living with HIV.

Short Communication: Discordance of HIV-1 Viral Load from Paired Blood and Seminal Plasma Samples in a Chinese Men Who Have Sex with Men Population.

The alarming spread of HIV among men who have sex with men (MSM) has become a national concern in China. Estimating men's sexual HIV infectiousness from blood plasma viral load (BPVL) depends on the association between BPVL and seminal plasma viral load (SPVL). However, previous studies were controversial and few concentrated on MSM. Twenty antiretroviral therapy (ART)-naive MSM and 54 MSM under ART were recruited between July and September 2015 in the city of Hangzhou, China. Blood and semen were collected in pairs at the same visit for each individual. BPVL and SPVL were measured by COBAS AmpliPrep/COBAS TaqMan HIV-1 Test ver2.0. The mean viral load in blood plasma was higher than that in semen (4.5 ± 0.9 log10 vs. 3.4 ± 1.3 log10) in 20 ART-untreated MSM, and a positive correlation was found between BPVL and SPVL, as evaluated by linear regression (R2 = 0.565, p < .001). A total of 96.3% (52/54) of ART-treated patients had successful viral suppression (<400 copies/mL) according to the BPVL. Fourteen subjects (25.9%, 14/54) presenting undetectable SPVL showed detectable BPVL, ranging from 20.4 to 7,470 copies/mL. Three subjects (5.6%, 3/54) presented detectable SPVL although BPVL was undetectable. MSM could pose a transmission risk despite undetectable BPVL. Consistent use of condoms and other risk-reduction strategies should be strongly advocated in MSM throughout all stages of HIV infection, regardless of ART.

Distinguishing Brain Impact of Aging and HIV Severity in Chronic HIV Using Multiparametric MR Imaging and MR Spectroscopy.

BackgroundCombination antiretroviral therapy (cART) has transformed HIV into a manageable but complex chronic disease, in which it is uncertain which brain insults may relate to age vs initial disease severity. We evaluate N-acetyl-aspartate/creatine (NAA/Cr), white matter hyperintensities (WMH), and mean cortical thickness to identify which subclinical markers of brain insult best relate to CD4 nadir and aging. This is a prospective study of the association between brain markers with age and initial infection severity, based on CD4 nadir, in chronic HIV patients.MethodsThirty-seven chronic HIV patients (age 25–77 years) with successful viral suppression were scanned on a GE 3T magnetic resonance imaging scanner to obtain NAA/Cr (standardized and averaged over 5 brain regions), log-transformed WMH volume, and mean cortical thickness. The brain measures were fitted with both CD4 nadir and age to evaluate the significance of their relationship.ResultsNAA/Cr, WMH, and cortical thickness were all correlated with age and CD4 nadir in unadjusted associations. Stepwise regression models showed that NAA/Cr alone best predicted CD4 nadir (β = 40.1 ± 13.3; P = .005), whereas WMH (β = 2.3 ± .9; P = .02) and mean cortical thickness (β = –2.7 ± 6.6; P < .0001) together produced the best model fit with age. NAA/Cr was higher for HIV stage 1 (CD4 nadir ≥ 500 cells/ µL; n = 15) compared with stage 2 (200 ≥ CD4 nadir < 500; n = 13) and stage 3 (CD4 nadir < 200; n = 9; P < .01 for both).ConclusionsIn patients with effectively suppressed HIV, NAA reflects the subclinical brain impact of initial disease severity related to development of even mild immune compromise, whereas cortical thickness and WMH volume are useful to evaluate age-related changes.

Quality of life improvement, social stigma and antiretroviral treatment adherence: implications for long-term HIV/AIDS care

ABSTRACTBy 2020, the Vietnamese government has committed to having 90% of patients receiving ART as well as 90% of those on ART having successful viral suppression. Factors that influence adherence to ART among patients are essential to allowing the adequate care. This study was conducted across 8 outpatient clinics in Hanoi and Nam Dinh province and included 1133 patients living with HIV. Socioeconomic factors such as marital status, education, employment as well as health-related quality of life improvements were investigated as potentially being associated with adherence rates of ART patients. Through multivariate logistic regression analysis with self-reported ART adherence and VAS scores, this study was able to identify marital status and employment as two factors associated with positive adherence scores. Similarly, health problems, stigmatization, and duration on ART were associated negatively with ART adherence. Knowing that these factors may be linked to adherence rates, they can be preemptively managed with patients to enhance adherence rates and achieve successful viral suppression.

Combating the HIV reservoirs

Impressive advances have been made in the treatment and management of HIV-1 infected individuals. Combination antiretroviral therapy (cART) has turned HIV-1 infection from an almost invariable deadly infectious disease, to a lifelong manageable infectious disease. However, a cure or vaccine has not been forthcoming. A major problem in HIV-1 infection is the persistent and latently infected cellular and tissue reservoirs. One of these reservoirs is the Gut Associated Lymphoid tissue (GALT), which has been the research focus of our group. Our group and others have shown that HIV-1 evolves differently in different parts of the gastro intestinal tract, which also appears to affect the development of antiretroviral drug resistance. The GALT is not the only reservoir. HIV-1 continues to persist and evolve in various other cell and tissue reservoirs despite intense and apparent successful antiretroviral therapy. Moreover, drug resistance mutations remain prevalent under therapy and successful viral suppression. In addition to finding a vaccine, the research on combating and eradicating the HIV-1 viral reservoirs has also been an important focus of HIV-1 cure strategies. We will discuss some of the research findings on reservoirs in the context of some of the HIV-1 cure approaches.

Need For HBV Cure: Persistent Risk For Subsequent New And Recurrent HCC Even After A Decade Of Successful Anti-HBV Therapy And Initial Tumor Ablation

Since 1998 with the highly effective nucleos(t)ide analogues for Hepatitis B virus (HBV), we have witnessed successful viral suppression that has led to the delay or prevention of the development of hepatocellular carcinoma (HCC). Reduced incidence of HCC with anti-HBV treatment has been documented with lamivudine, entecavir and tenofovir. A number of investigators have observed that after the initial tumor was ablated, anti-HBV treatment could prevent or reduce the recurrent or subsequent new HCC. Nonetheless, as reported earlier, we are observing the persistent risk for HCC in patients in spite of successful viral suppression for over a decade with anti-HBV therapy. In this report, we present three cases who underwent initial tumor ablation and maintained negative HBV DNA with anti-HBV therapy and yet developed subsequent new or recurrent HCC at the intervals of 5,10,11 and 15 years. These persistent risks for new and recurrent HCC are attributed to the incomplete control of HBV due to the presence of cccDNA in the host’s hepatocytes. Current antiviral treatment can achieve a functional cure (suppression of HBV replication) while a complete cure of eliminating the cccDNA has not been possible. Therefore, even though HBV is not actively replicating, cccDNA remains in the nucleus of the hepatocytes and continues hepatocarcinogenic processes including HBV and host DNA integration. There is a need for HBV cure drugs.

Imbalance in the game of T cells: What can the CD4/CD8 T-cell ratio tell us about HIV and health?

Antiretroviral treatment (ART) has transformed human immunodeficiency virus (HIV) from a deadly disease to a chronic illness that potentially has little effect on life expectancy. Modern ART can eliminate viremia and lower the risk of transmission. National data from the United States demonstrate that 81% of infected individuals receiving ART are virally suppressed [1]. With treatment available, HIV morbidity and mortality are not determined by opportunistic infections or AIDS-defining illnesses but rather by non-AIDS–defining conditions, including cardiovascular disease, liver disease, kidney disease, malignancies, neurocognitive disorders, and even autoimmune diseases [2]. To some, autoimmunity coexisting with HIV may be surprising; however, its presence illustrates how HIV’s immunopathology is more consistent with immune dysfunction than immune suppression alone. HIV viral load and the resulting decrease in absolute CD4 T cells have historically served as biomarkers for HIV’s immune suppression and response to treatment. However, with successful modern ART and viral suppression, absolute CD4 count and HIV viral load may not accurately reflect the risks facing patients because immune dysfunction persists despite normalization of CD4 counts [3]. One explanation is that these markers fail to truly describe HIV’s overall immune dysfunction contributing to today’s morbidity and mortality. The CD4/CD8 ratio more accurately describes this overall immune dysfunction and may be a better biomarker for disease progression, response to treatment, morbidity, and mortality for the virally suppressed. A greater understanding of the CD4/CD8 ratio and the impact of its manipulation should be a target for future HIV research.

Persistent Risk for HBV Associated Hepatocellular Carcinoma in spite of Sustained and Successful Viral Suppression: The Need for Drugs for HBV Cure

Persistent Risk for HBV Associated Hepatocellular Carcinoma in spite of Sustained and Successful Viral Suppression: The Need for Drugs for HBV Cure

An Innovative Approach to Addressing the HIV Care Continuum: Implementation of a Clinical Pharmacy Resident in a Veterans Affairs HIV Specialty Clinic

Purpose: Engagement of patients in the HIV care continuum and adherence to antiretroviral therapy (ART) continue to limit successful viral suppression. Innovative practices to improve this continuum and ameliorate potential physician shortages are needed. The objective of this evaluation was to determine the clinical benefits of incorporating pharmacy resident involvement on a multidisciplinary team in caring for patients with HIV. Methods: A single-center pre–post cohort pilot evaluation was conducted at the Tennessee Valley Healthcare Systems VA Medical Center. Patients were enrolled in an HIV pharmacotherapy clinic implemented by an ambulatory care pharmacy resident. The primary end point of the evaluation was the percentage of patients achieving an undetectable plasma HIV viral load after enrollment. Secondary end points included change from baseline in CD4 T-cell count and self-reported adherence. Results: A total of 55 patients were seen in the HIV pharmacotherapy clinic over a 28-week evaluation period. Of those patients with detectable viral load at enrollment, 70% reached viral suppression during follow-up, with a significant 0.75 log10 decrease in the median viral load (P < .0001 for both). The median CD4 T-cell count increased from 464 to 525 cells/mm3 (P = .01). Reported adherence, assessed using the Visual Analogue adherence Scale (VAS) increased significantly (P = .0001). Conclusion: After enrollment in an HIV pharmacotherapy clinic, a significant decrease in viral load was seen, as were improvements in secondary end points of CD4 T cells and adherence. These data demonstrate the clinical benefits of pharmacy resident involvement on a multidisciplinary team in caring for patients with HIV.

Highlights from the Conference on Retroviruses and Opportunistic Infections 2016

The ultimate test of HIV remission is maintenance of undetectable plasma viraemia off antiretroviral therapy. Several studies, both past and recent have explored how common this phenomenon is and what factors predict successful viral control where present. There is no unifying definition of post-treatment control (PTC), in terms of length of time plasma viral load (VL) remains below a certain threshold and comparison between studies demonstrates a variable definition of the phenotype. Table 1 summarises studies presented at the meeting where individuals were enrolled into a carefully monitored analytical treatment interruption (ATI) strategy. Overall, despite many years of successful viral suppression and CD4 recovery, PTC was uncommon. Where virus rebounded, this occurred generally within the first 2–8 weeks after ATI