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Virological remission after antiretroviral therapy interruption in female African HIV seroconverters.

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Title: Virological remission after antiretroviral therapy interruption in female African HIV seroconverters.
Authors: Gossez, M
Martin, GE
Pace, M
Ramjee, G
Premraj, A
Kaleebu, P
Rees, H
Inshaw, J
Stöhr, W
Meyerowitz, J
Hopkins, E
Jones, M
Hurst, J
Porter, K
Babiker, A
Fidler, S
Frater, J
SPARTAC Trial Investigators
Item Type: Journal Article
Abstract: INTRODUCTION: There are few data on the frequency of virological remission in African individuals after treatment with antiretroviral therapy (ART) in primary HIV infection (PHI). METHODS: We studied participants (n = 82) from South Africa and Uganda in Short Pulse Antiretroviral Treatment at HIV-1 Seroconversion, the first trial of treatment interruption in African individuals with PHI randomized to deferred ART or 48 weeks of immediate ART. All were female and infected with non-B HIV subtypes, mainly C. We measured HIV DNA in CD4 T cells, CD4 cell count, plasma viral load (pVL), cell-associated HIV RNA and T-cell activation and exhaustion. We explored associations with clinical progression and time to pVL rebound after treatment interruption (n = 22). Data were compared with non-African Short Pulse Antiretroviral Treatment at HIV-1 Seroconversion participants. RESULTS: Pretherapy pVL and integrated HIV DNA were lower in Africans compared with non-Africans (median 4.16 vs. 4.72 log10 copies/ml and 3.07 vs. 3.61 log10 copies/million CD4 T cells, respectively; P < 0.001). Pre-ART HIV DNA in Africans was associated with clinical progression (P = 0.001, HR per log10 copies/million CD4 T cells increase (95% CI) 5.38 (1.95-14.79)) and time to pVL rebound (P = 0.034, HR per log10 copies/ml increase 4.33 (1.12-16.84)). After treatment interruption, Africans experienced longer duration of viral remission than non-Africans (P < 0.001; HR 3.90 (1.75-8.71). Five of 22 African participants (22.7%) maintained VL less than 400 copies/ml over a median of 188 weeks following treatment interruption. CONCLUSION: We find evidence of greater probability of virological remission following treatment interruption among African participants, although we are unable to differentiate between sex, ethnicity and viral subtype. The finding warrants further investigation.
Issue Date: 1-Feb-2019
Date of Acceptance: 1-Feb-2019
URI: http://hdl.handle.net/10044/1/69487
DOI: https://dx.doi.org/10.1097/QAD.0000000000002044
Start Page: 185
End Page: 197
Journal / Book Title: AIDS
Volume: 33
Issue: 2
Copyright Statement: © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under theterms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform,and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.
Sponsor/Funder: Imperial College Healthcare NHS Trust- BRC Funding
Medical Research Council (MRC)
St Marys Development Trust
Medical Research Council (MRC)
Imperial College Healthcare NHS Trust- BRC Funding
Funder's Grant Number: RDA02 79560
MR/L00528X/1
N/A
n/a
RDA02
Keywords: Science & Technology
Life Sciences & Biomedicine
Immunology
Infectious Diseases
Virology
Africa
antiretroviral therapy
HIV
posttreatment control
remission
treatment interruption
BLOOD MONONUCLEAR-CELLS
DISEASE PROGRESSION
SUBTYPE-C
RNA LEVELS
TYPE-1 INFECTION
VIRAL LOAD
ACTIVATION
COUNT
DNA
INDIVIDUALS
SPARTAC Trial Investigators
06 Biological Sciences
11 Medical and Health Sciences
17 Psychology and Cognitive Sciences
Publication Status: Published
Conference Place: England
Online Publication Date: 2019-02-01
Appears in Collections:Department of Medicine
Faculty of Medicine



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