Rapid viral rebound after analytical treatment interruption in patients with very small HIV reservoir and minimal on‐going viral transcription

Pieter Pannus; Sofie Rutsaert; Stéphane De Wit; Sabine D Allard; Guido Vanham; Basiel Cole; Coca Nescoi; Joeri Aerts; Ward De Spiegelaere; Achilleas Tsoumanis; Marie‐Madeleine Couttenye; Natacha Herssens; Marie‐Angélique De Scheerder; Linos Vandekerckhove; Eric Florence

doi:10.1002/jia2.25453

journal article Open Access Feb 01, 2020

Rapid viral rebound after analytical treatment interruption in patients with very small HIV reservoir and minimal on‐going viral transcription

Pieter Pannus

Sofie Rutsaert Stéphane De Wit Sabine D Allard Guido Vanham Basiel Cole Coca Nescoi Joeri Aerts Ward De Spiegelaere

Achilleas Tsoumanis

Marie‐Madeleine Couttenye Natacha Herssens Marie‐Angélique De Scheerder

Linos Vandekerckhove

Eric Florence

Journal of the International AIDS Society Vol. 23 No. 2 · Wiley

View at Publisher Save 10.1002/jia2.25453

Abstract

AbstractIntroductionViral remission after analytical treatment interruption (ATI), termed post‐treatment control, has been described in a small proportion of HIV‐positive patients. This phenomenon has been separately associated to both low levels of HIV‐1 proviral DNA as well as cell‐associated RNA. We investigated whether the combination of both parameters could help predict delayed viral rebound after treatment interruption (TI).MethodsWe conducted an open single‐arm ATI study in four Belgian HIV reference centres from January 2016 to July 2018. Eligible participants were adults who had fewer than 50 HIV‐1 RNA copies/mL for more than two years, more than 500 CD4 cells/µL for more than three months, and were in general good health. Consenting participants who had fewer than 66 copies total HIV‐1 DNA (t‐DNA) and fewer than 10 copies cell‐associated HIV‐1 unspliced RNA (US‐RNA) per million peripheral blood mononuclear cells (PBMCs), interrupted therapy and were monitored closely. Antiretroviral therapy (ART) was resumed after two consecutive viral loads exceeding 1000 copies or one exceeding 10,000 copies/mL. The primary outcome was the proportion of participants with fewer than 50 HIV‐1 RNA copies/mL 48 weeks after TI. Secondary outcomes were time to viral rebound, the frequency of serious adverse events (AEs) and evolution of t‐DNA and US‐RNA after TI.ResultsAll 16 consenting participants who interrupted therapy experienced rapid viral rebound two to eight weeks after TI. No serious AEs were observed. Levels of t‐DNA and US‐RNA increased after TI but returned to pre‐ATI levels after treatment restart. None of the studied demographic, clinical and biological parameters were predictive of time of viral rebound.ConclusionsThe combination of low levels of t‐DNA and US‐RNA in PBMCs, corresponding respectively to a small and transcriptionally silent viral reservoir, is not predictive of viral remission after TI in patients on ART.

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Details

Published: Feb 01, 2020
Vol/Issue: 23(2)
License: View

Authors

P

Pieter Pannus

Departments of Clinical and Biomedical Sciences Institute of Tropical Medicine Antwerp Belgium; Department of Biomedical Sciences University of Antwerp Antwerp Belgium

S

Sofie Rutsaert

Department of General Internal Medicine HIV Cure Research Centre Ghent University Hospital and Ghent University Ghent Belgium

S

Stéphane De Wit

Saint Pierre University Hospital Université Libre de Bruxelles Brussels Belgium

S

Sabine D Allard

HIV Reference Centre Universitair Ziekenhuis Brussel Brussels Belgium

G

Guido Vanham

Departments of Clinical and Biomedical Sciences Institute of Tropical Medicine Antwerp Belgium; Department of Biomedical Sciences University of Antwerp Antwerp Belgium

B

Basiel Cole

Department of General Internal Medicine HIV Cure Research Centre Ghent University Hospital and Ghent University Ghent Belgium

C

Coca Nescoi

Saint Pierre University Hospital Université Libre de Bruxelles Brussels Belgium

J

Joeri Aerts

Vrije Universiteit Brussel Brussels Belgium

W

Ward De Spiegelaere

Department of Morphology Faculty of Veterinary Medicine Ghent University Ghent Belgium

A

Achilleas Tsoumanis

Departments of Clinical and Biomedical Sciences Institute of Tropical Medicine Antwerp Belgium

M

Marie‐Madeleine Couttenye

Antwerp University Hospital University of Antwerp Antwerp Belgium

N

Natacha Herssens

Departments of Clinical and Biomedical Sciences Institute of Tropical Medicine Antwerp Belgium

M

Marie‐Angélique De Scheerder

Department of General Internal Medicine HIV Cure Research Centre Ghent University Hospital and Ghent University Ghent Belgium

L

Linos Vandekerckhove

Department of General Internal Medicine HIV Cure Research Centre Ghent University Hospital and Ghent University Ghent Belgium

E

Eric Florence

Departments of Clinical and Biomedical Sciences Institute of Tropical Medicine Antwerp Belgium

Cite This Article

Pieter Pannus, Sofie Rutsaert, Stéphane De Wit, et al. (2020). Rapid viral rebound after analytical treatment interruption in patients with very small HIV reservoir and minimal on‐going viral transcription. Journal of the International AIDS Society, 23(2). https://doi.org/10.1002/jia2.25453

Rapid viral rebound after analytical treatment interruption in patients with very small HIV reservoir and minimal on‐going viral transcription

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