Journal
JOURNAL OF THE PEDIATRIC INFECTIOUS DISEASES SOCIETY
Volume 10, Issue 3, Pages 295-301Publisher
OXFORD UNIV PRESS
DOI: 10.1093/jpids/piaa071
Keywords
adolescents; children; early treated; HIV-1; HIV reservoir; viral suppression
Categories
Funding
- EPIICAL (EarlyTreated Perinatally HIV-Infected Individuals: Improving Children's Actual Life With Novel Immunotherapeutic Strategies) project - ViiV Healthcare United Kingdom
- PENTA-ID foundation
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This study investigated factors associated with lower levels of total HIV-1 DNA in perinatal HIV infection, finding that younger age and lower VL at ART initiation were linked to reduced reservoir size.
Background. Strategies aimed at antiretroviral therapy (ART)-free remission will target individuals with a limited viral reservoir. We investigated factors associated with low reservoir measured as total human immunodeficiency virus type 1 (HIV-1) DNA in peripheral blood mononuclear cells (PBMCs) in perinatal infection (PaHIV). Methods. Children from 7 European centers in the Early Treated Perinatally HIV Infected Individuals: Improving Children's Actual Life (EPIICAL) consortium who commenced ART aged <2 years, and remained suppressed (viral load [VL] <50 copies/mL) for >5 years were included. Total HIV-1 DNA was measured by quantitative polymerase chain reaction per million PBMCs. Factors associated with total HIV-1 DNA were analyzed using generalized additive models. Age, VL at ART initiation, and baseline CD4% effects were tested including smoothing splines to test nonlinear association. Results. Forty PaHIV, 27 (67.5%) female 21 (52.5%) Black/Black African, had total HIV-1 DNA measured; median 12 (IQR, 7.3-15.4) years after ART initiation. Eleven had total HIV-1 DNA <10 copies/10(6) PBMCs. HIV-1 DNA levels were positively associated with age and VL at ART initiation, baseline CD4%, and Western blot antibody score. Age at ART initiation presented a linear association (coefficient = 0.10 +/- 0.001, P <= .001), the effect of VL (coefficient = 0.35 +/- 0.1, P <= .001) noticeable >6 logs. The effect of CD4% (coefficient = 0.03 +/- 0.01, P <= .049) was not maintained >40%. Conclusions. In this PaHIV cohort, reduced total HIV-1 DNA levels were associated with younger age and lower VL at ART initiation. The impact of early-infant treatment on reservoir size persists after a decade of suppressive therapy.
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