Virological blips and predictors of post treatment viral control after stopping ART started in Primary HIV infection. Journal of Acquired Immune Deficiency Syndromes
Fidler et al. on behalf of CASCADE collaboration in EuroCoord explored the frequency, magnitude, and predictive value of measured viral blips on the probability of achieving post treatment control (PTC) among a cohort of treated HIV-1 seroconverters interrupting ART initiated in primary HIV infection (PHI).
The authors used a modified definition of blip as a single plasma HIV-RNA measure >400 cp/mL in a previously suppressed individual followed by subsequent viral suppression (
Seven-hundred-seventy-eight individuals started ART within 6 months of seroconversion and had at least 3 HIV-RNA measurements, of these 228 (30%) subsequently stopped ART. Median ART duration was 16.2 months. Among the 228 individuals stopping ART, 22 (10%) individuals fulfilled the definition of PTC. Each blip >400 cp/mL was associated with a 71% increased risk of loss of control. Conversely, longer time spent on ART was independently associated with a decreased risk in loss of control. There was no evidence of an association between loss of control and CD4 T-cell count at ART initiation, ART initiation class, seroconversion age, sex, or HIV-1 transmission risk group.
In conclusion, the study-findings indicate that the absence of viral blips >400 copies HIV-1 RNA/mL on therapy in individuals treated with early ART predict a better chance of subsequent post treatment viremic control after ART cessation.