Factors associated with a low HIV reservoir in patients with prolongedsuppressive antiretroviral therapy

Objectives: The relevance of low-level HIV DNA in patients who have undergone prolonged therapy is not well understood. The objective of this study was to determine factors that influence the establishment of low-level HIV DNA in long-term treated patients (excluding treatment since acute infection). Methods: This was a cross-sectional study involving 243 patients receiving highly active antiretroviral therapy (HAART) for ≥6 months (median: 9 years of treatment) with plasma HIV RNA,50 copies/mL at the study timepoint, forwhomtotalDNAmeasurements were performed. Patients treated since early acute infection or receiving cancer chemotherapeutic/immunosuppressive agents were excluded from the study. Results:Overall, themedianHIVDNAwas372 copies/106 peripheral bloodmononuclearcells (PBMCs). Forty-seven patients had levels of HIV DNA below the limit of detection and 58 patients had low-level HIV DNA (,100 copies/ 106 PBMCs). In multivariate analysis, a low total HIV DNA in HAART-treated patients was clearly associated with a low HIV RNA pre-therapeutic viral load (P,0.0001), regardless of the cut-off used. Conclusions: These results may be helpful to identify candidates for future trials aiming at a functional cure of HIV infection, since lowtotal HIVDNAlevels will mostlikely be a prerequisite of successful immunological control of HIV replication. © The Author 2013. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.