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. 2018 Jul;24(7):923-926.
doi: 10.1038/s41591-018-0026-6. Epub 2018 Jun 11.

Rapid HIV RNA rebound after antiretroviral treatment interruption in persons durably suppressed in Fiebig I acute HIV infection

Donn J Colby  1 , Lydie Trautmann  2   3 , Suteeraporn Pinyakorn  2   3 , Louise Leyre  4 , Amélie Pagliuzza  4 , Eugène Kroon  1 , Morgane Rolland  2   3 , Hiroshi Takata  2   3 , Supranee Buranapraditkun  2   3   5   6 , Jintana Intasan  1 , Nitiya Chomchey  1 , Roshell Muir  7 , Elias K Haddad  7 , Sodsai Tovanabutra  2   3 , Sasiwimol Ubolyam  8 , Diane L Bolton  2   3 , Brandie A Fullmer  9 , Robert J Gorelick  9 , Lawrence Fox  10 , Trevor A Crowell  2   3 , Rapee Trichavaroj  11 , Robert O'Connell  11 , Nicolas Chomont  4 , Jerome H Kim  2   12 , Nelson L Michael  2 , Merlin L Robb  2   3 , Nittaya Phanuphak  1 , Jintanat Ananworanich  13   14   15   16 ; RV411 study group
Collaborators, Affiliations

Rapid HIV RNA rebound after antiretroviral treatment interruption in persons durably suppressed in Fiebig I acute HIV infection

Donn J Colby et al. Nat Med. 2018 Jul.

Abstract

Antiretroviral therapy during the earliest stage of acute HIV infection (Fiebig I) might minimize establishment of a latent HIV reservoir and thereby facilitate viremic control after analytical treatment interruption. We show that 8 participants, who initiated treatment during Fiebig I and were treated for a median of 2.8 years, all experienced rapid viral load rebound following analytical treatment interruption, indicating that additional strategies are required to control or eradicate HIV.

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Conflict of interest statement

COMPETING FINANCIAL INTERESTS

TC has received a speaker’s fee from Gilead. JA has received honorarium for participating in advisory meetings from Merck, Roche, AbbVie and ViiV Healthcare. All other authors declare no competing financial interests.

Figures

Figure 1
Figure 1
Viral load (VL) rebound following ATI in eight Fiebig I acutely treated participants. (a) Median (range) time to VL rebound >20 copies/ml was 26 (13-48) days. (b) Pre-ATI peripheral blood CD4+ T/CD8 ratio ≤1 was associated with faster time to VL rebound >20 copies/ml after ATI. (c) HIV-1 phylogenetic trees based on pro- rt sequences sampled in acute infection (F, gray) and following VL rebound (R, black). The number of mutations away from the founder consensus is figured as a suffix.
Figure 2
Figure 2
Longitudinal HIV reservoir markers and immune responses. (a) Frequencies of peripheral blood CD4+ T cells harboring total HIV DNA after ART resumption were not different to baseline values. (b) Total HIV DNA in CD4+ T cells prior to ATI was not significantly associated with time to VL rebound > 20 copies/ml post-ATI. Open symbols depict levels below the limit of detection of the assay. (c) Effector Ki67+CD8+ T cells expanded rapidly following VL rebound in all participants. (d) Envelope (ENV)-specific IgG levels were higher following VL rebound in 4 of 8 participants (4617, 6054, 6579, 4320). (e) The frequencies of Ki67+CD8+ T cells and (f) plasma ENV-IgG levels were negatively associated with the highest observed viral load levels at ART resumption.
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