A High HIV DNA Level in PBMCs at Antiretroviral Treatment Interruption Predicts a Shorter Time to Treatment Resumption Independently of CD4 Nadir

Christophe Piketty (1) , Laurence Weiss , Lambert Assoumou , Marianne Burgard (2) , Aurelie Melard (2) , Jean-Michel Ragnaud , Michele Bentata , Pierre Marie Girard (3) , Christine Rouzioux (2) , Dominique Costagliola

1 Service d'Immunologie Clinique, Hôpital Européen Georges Pompidou, Paris
2 Hôpital Necker - Enfants Malades [AP-HP]
3 Infectious disease

This study aimed to evaluate the safety of antiretroviral treatment interruption(TI) in HIV-infected patients who started treatment based on earlier guidelines, and to identify baseline factors predictive of the time to reach fixed criteria for treatment resumption. Prospective, open-label, multicentre trial. Patients were eligible if they had a CD4 cell count>350/mm3 and plasma HIV RNA<50000 copies/ml when they first started antiretroviral therapy(ART); and if they had a CD4 count>450/mm3 and stable plasma HIV RNA<5000 copies/mL for at least six months prior to enrolment. The criteria for ART resumption were a CD4 cellcount<300/mm3 and/or a CDC stage BorC event. 116 patients had received ART for a median of 5.3 years. The median CD4 cell count and plasma HIV RNA values at inclusion were 809/mm3 and 2.6 logcopies/mL, respectively. Median HIV DNA load at inclusion was 2.3 logcopies/106PBMCs. Thirty-six months after TI, 63.9% of the patients had not yet reached the criteria for ART resumption, and 55.9% of patients had not resumed ART. In Cox multivariable analysis, a high HIV DNA level at TI, a low CD4 nadir, and pre-existing AIDS status were the only significant risk factors for reaching the criteria for ART resumption (hazards ratio: 2.15(1.02-4.53), 4.59(1.22–17.24) and 5.74(1.60–20.56), respectively). Patients who started ART with a CD4 cell count above 350/mm3 were able to interrupt treatment for long periods without a high absolute risk of either AIDS or severe non-AIDS morbidity/mortality. A high PBMC HIV DNA level at TI was a strong predictor for more rapid treatment resumption.

Mots clés: Medicine

Christophe Piketty, Laurence Weiss, Lambert Assoumou, Marianne Burgard, Aurelie Melard, et al.. A High HIV DNA Level in PBMCs at Antiretroviral Treatment Interruption Predicts a Shorter Time to Treatment Resumption Independently of CD4 Nadir. Journal of Medical Virology, 2010, 82 (11), pp.1819. ⟨10.1002/jmv.21907⟩. ⟨hal-00577327⟩