Higher HIV-1 DNA associated with lower gains in CD4 cell count among patients with advanced therapeutic failure receiving optimized treatment (ANRS 123-ETOILE)

To describe HIV-1 DNA levels from baseline (W0) to week 52 (W52) among patients receiving either interleukin-2 (IL-2) + optimized background therapy (OBT) or OBT as salvage treatment. This was evaluated in a substudy of the ETOILE Agence Nationale de Recherches sur le SIDA et les hepatites virales (ANRS) 123 trial (patients with CD4 < 200/mm(3), HIV RNA > 4 log(10) copies/mL and a genotypic score showing two or fewer active drugs). OBT included enfuvirtide whenever possible. HIV DNA was quantified with the ANRS assay. Blood samples were available for 21 patients in the IL-2 + OBT arm and 23 in the OBT alone arm at baseline, and for 10 and 17 patients, respectively, at W52. Median baseline CD4 count was 47 cells/mm(3) and 68 cells/mm(3), respectively; median HIV RNA was 5.1 and 4.9 log(10) copies/mL. Baseline median HIV DNA load was 3.44 log(10) copies/10(6) peripheral blood mononuclear cells (PBMCs) (interquartile range 3.31-4.08) and 3.51 (3.18-3.82) log(10) copies/10(6) PBMCs, respectively. At W52, it was 3.18 log(10) copies/10(6) PBMCs (2.75-3.52) and 3.48 log(10) copies/10(6) PBMCs (3.10-3.67), respectively. Cells were available at both W0 and W52 for 7 patients in the IL-2 + OBT arm and 14 in the OBT arm. Change in HIV DNA load was not associated with IL-2 use, but decreased among the seven patients receiving enfuvirtide (-0.22 log(10) copies/mL) as compared with the other 14 patients (+0.20 log(10); P = 0.046). A steeper decrease in HIV DNA was observed among patients who had a larger increase in CD4 count (Pearson coefficient = 0.659, P = 0.001). Adjusted for enfuvirtide use, there was a trend for an association between upper baseline HIV DNA level and a less frequent CD4 gain >= 50 cells/mm(3) at W52 (odds ratio = 0.17, P = 0.075). HIV DNA levels were high in patients with advanced therapeutic failure. A larger viral reservoir may be associated with lower gains in CD4 count among patients receiving OBT. HIV DNA level could be a useful tool for the case management of patients in the late stages of disease.