Role of the HIV-1 reservoir to maintain viral suppression in a simplified strategy for the long-term management of HIV-1 infection (The SIMPL’HIV Trial). Frontiers in Virology
Branca et al. assessed the association between the size of the HIV reservoir and the maintenance of HIV viral suppression among participants of the SIMPL’HIV Trial.
The SIMPL’HIV Trial was a randomized controlled trial conducted within the Swiss HIV Cohort Study that compared the efficacy of dual therapy (dolutegravir and emtricitabine) with the standard of care. In the study participants, HIV reservoir size was assessed by quantifying HIV-1 DNA in peripheral blood mononuclear cells. The authors assessed changes in reservoir size over time and evaluated if reservoir size predicts whether patients continue to have HIV viral suppression (<20 copies/mL) during the 48-week study period using multivariable logistic regression.
In the present study, 175 patients with available HIV-1 DNA reservoir data were included. The median age was 48 years, median CD4 were 240 cells/mL (nadir) and 669 cells/mL (baseline), and patients received ART for a median of 7.8 years prior to randomization. The HIV reservoir size at baseline was similar in both the dual therapy (3.10 log10 HIV DNA copies, IQR 2.81-3.30) and the standard of care arm (3.05, 2.76-3.32), and remained unchanged at 48 weeks. Over time, 45 patients had a detectable HIV viral load on one or more occasions. After adjusting for the time since first ART start and nadir CD4, higher HIV-1 DNA levels were strongly associated with having a detectable HIV viral load during follow-up (adjusted Odds Ratio 2.67 per log10 HIV DNA copy, 95% CI 1.13-6.32).
In summary, the present study illustrates the stability of the HIV reservoir over time in individuals with a long-standing HIV infection and shows that individuals with a large HIV reservoir were more likely to have a detectable HIV viral load on antiretroviral therapy.