A low HIV-DNA level in peripheral blood mononuclear cells at antiretroviral treatment interruption predicts a higher probability of maintaining viral control

Objective:The main aim of this study was to determine whether HIV replication can be controlled following interruption of treatment started early in the course of infection (CD4(+) >350cells/l and viral load <50000copies/ml), but not during the primary infection.Methods:Patients enrolled in a multicenter trial of treatment interruption (ANRS 116 SALTO) with CD4(+) above 450cells/l and viral load below 400copies/ml at treatment interruption were selected for this second analysis. We determined the proportion of patients whose plasma HIV-RNA load remained below 400copies/ml during the first 12 months of treatment interruption, and baseline factors predictive of time to loss of viral control. Viral load rebound was defined as two successive values above 400copies/ml, or as one value above 400copies/ml, followed by treatment resumption.Results:We studied 95 patients with a median CD4(+) nadir of 382cells/l (340-492). At treatment interruption, the median CD4(+) cell count and HIV-DNA load were 813/l (695-988) and 206copies/10(6) peripheral blood mononuclear cells (PBMCs) (53-556). Twelve months after treatment interruption, seven patients still had viral load below 400copies/ml (Kaplan-Meier estimate 7.5%, 95% confidence interval 3.7-14.6), and four of them still had viral load below 400copies/ml at 36 months. A multivariable Cox proportional-hazards model showed that time to loss of viral control was more shorter in patients with HIV-DNA at least 150copies/10(6) PBMCs at treatment interruption (hazard ratio 2.1, 95% confidence interval 1.3-3.3, P=0.002) than in those with HIV-DNA below 150copies/10(6) PBMCs.Conclusion:Patients who have low HIV-DNA levels at antiretroviral treatment interruption are more likely to maintain viral control for long periods. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.