Early and Highly Suppressive Antiretroviral Therapy Are Main Factors Associated With Low Viral Reservoir in European Perinatally HIV-Infected Children

Alfredo Tagarro, Man Chan, Paola Zangari, Bridget Ferns, Caroline Foster, Anita De Rossi, Eleni Nastouli, María A Muñoz-Fernández, Diana Gibb, Paolo Rossi, Carlo Giaquinto, Abdel Babiker, Claudia Fortuny, Riccardo Freguja, Nicola Cotugno, Ali Judd, Antoni Noguera-Julian, María Luisa Navarro, María José Mellado, Nigel KleinPaolo Palma, Pablo Rojo

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Future strategies aiming to achieve HIV-1 remission are likely to target individuals with small reservoir size.

SETTING: We retrospectively investigated factors associated with HIV-1 DNA levels in European, perinatally HIV-infected children starting antiretroviral therapy (ART) <6 months of age.

METHODS: Total HIV-1 DNA was measured from 51 long-term suppressed children aged 6.3 years (median) after initial viral suppression. Factors associated with log10 total HIV-1 DNA were analyzed using linear regression.

RESULTS: At ART initiation, children were aged median [IQR] 2.3 [1.2-4.1] months, CD4% 37 [24-45] %, CD8% 28 [18-36] %, log10 plasma viral load (VL) 5.4 [4.4-5.9] copies per milliliter. Time to viral suppression was 7.98 [4.6-19.3] months. After suppression, 13 (25%) children had suboptimal response [≥2 consecutive VL 50-400 followed by VL <50] and/or experienced periods of virological failure [≥2 consecutive VL ≥400 followed by VL <50]. Median total HIV-1 DNA was 43 [6195] copies/10 PBMC. Younger age at therapy initiation was associated with lower total HIV-1 DNA (adjusted coefficient [AC] 0.12 per month older, P = 0.0091), with a month increase in age at ART start being associated with a 13% increase in HIV DNA. Similarly, a higher proportion of time spent virally suppressed (AC 0.10 per 10% higher, P = 0.0022) and the absence of viral failure/suboptimal response (AC 0.34 for those with fail/suboptimal response, P = 0.0483) were associated with lower total HIV-1 DNA.

CONCLUSIONS: Early ART initiation and a higher proportion of time suppressed are linked with lower total HIV-1 DNA. Early ART start and improving adherence in perinatally HIV-1-infected children minimize the size of viral reservoir.

Original languageEnglish
Pages (from-to)269-276
Number of pages8
JournalJournal of acquired immune deficiency syndromes (1999)
Volume79
Issue number2
DOIs
Publication statusPublished - Oct 1 2018

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    Tagarro, A., Chan, M., Zangari, P., Ferns, B., Foster, C., De Rossi, A., Nastouli, E., Muñoz-Fernández, M. A., Gibb, D., Rossi, P., Giaquinto, C., Babiker, A., Fortuny, C., Freguja, R., Cotugno, N., Judd, A., Noguera-Julian, A., Navarro, M. L., Mellado, M. J., ... Rojo, P. (2018). Early and Highly Suppressive Antiretroviral Therapy Are Main Factors Associated With Low Viral Reservoir in European Perinatally HIV-Infected Children. Journal of acquired immune deficiency syndromes (1999), 79(2), 269-276. https://doi.org/10.1097/QAI.0000000000001789