Limits...
HIV-1 DNA predicts disease progression and post-treatment virological control.

Williams JP, Hurst J, Stöhr W, Robinson N, Brown H, Fisher M, Kinloch S, Cooper D, Schechter M, Tambussi G, Fidler S, Carrington M, Babiker A, Weber J, Koelsch KK, Kelleher AD, Phillips RE, Frater J, SPARTACTrial Investigato - Elife (2014)

Bottom Line: With the aim of identifying individuals in whom ART might induce a period of viraemic control on stopping therapy, we hypothesised that quantification of the pool of latently infected cells in primary HIV-1 infection (PHI) would predict clinical progression and viral replication following ART.We measured HIV-1 DNA in a highly characterised randomised population of individuals with PHI.In multivariable analyses, HIV-1 DNA was more predictive of disease progression than plasma viral load and, at treatment interruption, predicted time to plasma virus rebound.

View Article: PubMed Central - PubMed

Affiliation: Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Oxford, United Kingdom.

ABSTRACT
In HIV-1 infection, a population of latently infected cells facilitates viral persistence despite antiretroviral therapy (ART). With the aim of identifying individuals in whom ART might induce a period of viraemic control on stopping therapy, we hypothesised that quantification of the pool of latently infected cells in primary HIV-1 infection (PHI) would predict clinical progression and viral replication following ART. We measured HIV-1 DNA in a highly characterised randomised population of individuals with PHI. We explored associations between HIV-1 DNA and immunological and virological markers of clinical progression, including viral rebound in those interrupting therapy. In multivariable analyses, HIV-1 DNA was more predictive of disease progression than plasma viral load and, at treatment interruption, predicted time to plasma virus rebound. HIV-1 DNA may help identify individuals who could safely interrupt ART in future HIV-1 eradication trials.

Show MeSH

Related in: MedlinePlus

HIV-1 DNA on ART predicts clinical progression following treatment interruption.Kaplan–Meier survival analyses for (A) Total (n = 47) and (B) Integrated (n = 47) HIV-1 DNA and clinical progression, based on time to the SPARTAC trial primary endpoint of a CD4 T cell count of 350 cells/μl or starting back on long-term ART. HIV-1 DNA data was divided into ‘high’ and ‘low’ at the median. Significance was determined by log rank test. Participants had received a median of 48 weeks of ART and then undertook a treatment interruption. DNA levels were measured at week 48, at the point of stopping ART. Time from TI to primary endpoint is plotted on the x-axis.DOI:http://dx.doi.org/10.7554/eLife.03821.012
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4199415&req=5

fig4: HIV-1 DNA on ART predicts clinical progression following treatment interruption.Kaplan–Meier survival analyses for (A) Total (n = 47) and (B) Integrated (n = 47) HIV-1 DNA and clinical progression, based on time to the SPARTAC trial primary endpoint of a CD4 T cell count of 350 cells/μl or starting back on long-term ART. HIV-1 DNA data was divided into ‘high’ and ‘low’ at the median. Significance was determined by log rank test. Participants had received a median of 48 weeks of ART and then undertook a treatment interruption. DNA levels were measured at week 48, at the point of stopping ART. Time from TI to primary endpoint is plotted on the x-axis.DOI:http://dx.doi.org/10.7554/eLife.03821.012

Mentions: We measured DNA levels in participants who received a median of 48 (IQR 47.7–48.7) weeks of ART with successfully suppressed viraemia (VL < 50 copies/ml plasma), immediately prior to treatment interruption. The demographics of the subset of individuals (n = 47) studied in this analysis are detailed in Supplementary file 1. Kaplan–Meier survival analyses were undertaken in which participants were again divided into two groups (low and high) based on median HIV-1 DNA levels at TI. Both low Total and Integrated HIV-1 DNA levels associated with a longer time to trial endpoint (p = 0.039 and 0.031, respectively; log-rank test) (Figure 4). The median time from TI to primary endpoint stratified by low and high Total HIV-1 DNA levels was 159.2 (IQR 111.9–200.6) and 117.8 (IQR 67.8–173.8) weeks, respectively, and by low and high Integrated levels was 166 (IQR 124.9–200.6) and 101.1 (IQR 65.5–156.8) weeks, respectively.10.7554/eLife.03821.012Figure 4.HIV-1 DNA on ART predicts clinical progression following treatment interruption.


HIV-1 DNA predicts disease progression and post-treatment virological control.

Williams JP, Hurst J, Stöhr W, Robinson N, Brown H, Fisher M, Kinloch S, Cooper D, Schechter M, Tambussi G, Fidler S, Carrington M, Babiker A, Weber J, Koelsch KK, Kelleher AD, Phillips RE, Frater J, SPARTACTrial Investigato - Elife (2014)

HIV-1 DNA on ART predicts clinical progression following treatment interruption.Kaplan–Meier survival analyses for (A) Total (n = 47) and (B) Integrated (n = 47) HIV-1 DNA and clinical progression, based on time to the SPARTAC trial primary endpoint of a CD4 T cell count of 350 cells/μl or starting back on long-term ART. HIV-1 DNA data was divided into ‘high’ and ‘low’ at the median. Significance was determined by log rank test. Participants had received a median of 48 weeks of ART and then undertook a treatment interruption. DNA levels were measured at week 48, at the point of stopping ART. Time from TI to primary endpoint is plotted on the x-axis.DOI:http://dx.doi.org/10.7554/eLife.03821.012
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4199415&req=5

fig4: HIV-1 DNA on ART predicts clinical progression following treatment interruption.Kaplan–Meier survival analyses for (A) Total (n = 47) and (B) Integrated (n = 47) HIV-1 DNA and clinical progression, based on time to the SPARTAC trial primary endpoint of a CD4 T cell count of 350 cells/μl or starting back on long-term ART. HIV-1 DNA data was divided into ‘high’ and ‘low’ at the median. Significance was determined by log rank test. Participants had received a median of 48 weeks of ART and then undertook a treatment interruption. DNA levels were measured at week 48, at the point of stopping ART. Time from TI to primary endpoint is plotted on the x-axis.DOI:http://dx.doi.org/10.7554/eLife.03821.012
Mentions: We measured DNA levels in participants who received a median of 48 (IQR 47.7–48.7) weeks of ART with successfully suppressed viraemia (VL < 50 copies/ml plasma), immediately prior to treatment interruption. The demographics of the subset of individuals (n = 47) studied in this analysis are detailed in Supplementary file 1. Kaplan–Meier survival analyses were undertaken in which participants were again divided into two groups (low and high) based on median HIV-1 DNA levels at TI. Both low Total and Integrated HIV-1 DNA levels associated with a longer time to trial endpoint (p = 0.039 and 0.031, respectively; log-rank test) (Figure 4). The median time from TI to primary endpoint stratified by low and high Total HIV-1 DNA levels was 159.2 (IQR 111.9–200.6) and 117.8 (IQR 67.8–173.8) weeks, respectively, and by low and high Integrated levels was 166 (IQR 124.9–200.6) and 101.1 (IQR 65.5–156.8) weeks, respectively.10.7554/eLife.03821.012Figure 4.HIV-1 DNA on ART predicts clinical progression following treatment interruption.

Bottom Line: With the aim of identifying individuals in whom ART might induce a period of viraemic control on stopping therapy, we hypothesised that quantification of the pool of latently infected cells in primary HIV-1 infection (PHI) would predict clinical progression and viral replication following ART.We measured HIV-1 DNA in a highly characterised randomised population of individuals with PHI.In multivariable analyses, HIV-1 DNA was more predictive of disease progression than plasma viral load and, at treatment interruption, predicted time to plasma virus rebound.

View Article: PubMed Central - PubMed

Affiliation: Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Oxford, United Kingdom.

ABSTRACT
In HIV-1 infection, a population of latently infected cells facilitates viral persistence despite antiretroviral therapy (ART). With the aim of identifying individuals in whom ART might induce a period of viraemic control on stopping therapy, we hypothesised that quantification of the pool of latently infected cells in primary HIV-1 infection (PHI) would predict clinical progression and viral replication following ART. We measured HIV-1 DNA in a highly characterised randomised population of individuals with PHI. We explored associations between HIV-1 DNA and immunological and virological markers of clinical progression, including viral rebound in those interrupting therapy. In multivariable analyses, HIV-1 DNA was more predictive of disease progression than plasma viral load and, at treatment interruption, predicted time to plasma virus rebound. HIV-1 DNA may help identify individuals who could safely interrupt ART in future HIV-1 eradication trials.

Show MeSH
Related in: MedlinePlus