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Virological remission after antiretroviral therapy interruption in female African HIV seroconverters

Gossez, M; Martin, GE; Pace, M; Ramjee, G; Premraj, A; Kaleebu, P; Rees, H; ... SPARTAC Trial Investigators, .; + view all (2019) Virological remission after antiretroviral therapy interruption in female African HIV seroconverters. AIDS , 33 (2) pp. 185-197. 10.1097/QAD.0000000000002044. Green open access

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Abstract

INTRODUCTION: There are few data on the frequency of virological remission in African individuals after treatment with antiretroviral therapy (ART) in primary HIV infection (PHI). METHODS: We studied participants (n = 82) from South Africa and Uganda in SPARTAC, the first trial of treatment interruption (TI) in African individuals with PHI randomized to deferred ART or 48 weeks of immediate ART. All were female and infected with non-B HIV subtypes, mainly C. We measured HIV DNA in CD4 T cells, CD4 count, plasma viral load (pVL), cell-associated HIV RNA and T cell activation and exhaustion. We explored associations with clinical progression and time to pVL rebound after TI (n = 22). Data were compared with non-African SPARTAC participants. RESULTS: Pre-therapy pVL and integrated HIV DNA were lower in Africans compared with non-Africans (median 4.16 vs 4.72 log10 copies/ml and 3.07 vs 3.61 log10 copies/million CD4 T-cells respectively; p < 0.001). Pre-ART HIV DNA in Africans was associated with clinical progression (p = 0.001, HR per log10 copies/million CD4 T cells increase (95% CI) 5.38 (1.95-14.79)) and time to pVL rebound (p = 0.034, HR per log10 copies/ml increase 4.33 (1.12-16.84)). After TI, Africans experienced longer duration of viral remission than non-Africans (p < 0.001; HR 3.90 (1.75-8.71). Five of 22 African participants (22.7%) maintained VL < 400 copies/ml over a median of 188 weeks following TI. CONCLUSION: We find evidence of greater probability of virological remission following TI among African participants, although we are unable to differentiate between sex, ethnicity and viral subtype. The finding warrants further investigation.

Type: Article
Title: Virological remission after antiretroviral therapy interruption in female African HIV seroconverters
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1097/QAD.0000000000002044
Publisher version: http://dx.doi.org/10.1097/QAD.0000000000002044
Language: English
Additional information: Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.
Keywords: HIV; antiretroviral therapy; treatment interruption; post-treatment control; remission; Africa
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Infection and Immunity
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
URI: https://discovery.ucl.ac.uk/id/eprint/10059630
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