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Immunologic Biomarkers, Morbidity, and Mortality in Treated HIV Infection

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Outcomes of HIV-associated Hodgkin lymphoma in the era of antiretroviral therapy

CD4+ and CD8+ T-cell kinetics in aviremic HIV-infected patients developing Hodgkin or non-Hodgkin lymphoma

CD8 T-Cell Expansion and Inflammation Linked to CMV Coinfection in ART-treated HIV Infection

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Association of immune-activation and senescence markers with non-AIDS-defining comorbidities in HIV-suppressed patients

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Levels of intracellular HIV-DNA in patients with suppressive antiretroviral therapy

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Influence of the Timing of Antiretroviral Therapy on the Potential for Normalization of Immune Status in Human Immunodeficiency Virus 1–Infected Individuals

Cross-sectional Comparison of the Prevalence of Age-Associated Comorbidities and Their Risk Factors Between HIV-Infected and Uninfected Individuals: The AGEhIV Cohort Study

CD4/CD8 ratio normalisation and non-AIDS-related events in individuals with HIV who achieve viral load suppression with antiretroviral therapy: an observational cohort study

Baseline HIV-1 resistance, virological outcomes, and emergent resistance in the SECOND-LINE trial: an exploratory analysis

Effects of statin therapy on coronary artery plaque volume and high-risk plaque morphology in HIV-infected patients with subclinical atherosclerosis: a randomised, double-blind, placebo-controlled trial

Low Bone Mineral Density in Patients With Well-Suppressed HIV Infection: Association With Body Weight, Smoking, and Prior Advanced HIV Disease

Early versus delayed initiation of highly active antiretroviral therapy for HIV-positive adults with newly diagnosed pulmonary tuberculosis (TB-HAART): a prospective, international, randomised, placebo-controlled trial

A chronic kidney disease risk score to determine tenofovir safety in a prospective cohort of HIV-positive male veterans

Single-agent tenofovir versus combination emtricitabine plus tenofovir for pre-exposure prophylaxis for HIV-1 acquisition: an update of data from a randomised, double-blind, phase 3 trial

Predicting the outcomes of treatment to eradicate the latent reservoir for HIV-1

Levels of intracellular HIV-DNA in patients with suppressive antiretroviral therapy
Published by Anton POZNAK

Updated: 15 November, 2015

Cuzin L et al. AIDS. 2015 Aug 24;29(13):1665-71.

This study assessed factors associated with HIV-DNA levels in chronically infected patients on long-term suppressive antiretroviral therapy. This was a cross-sectional, multicentre study of patients receiving ART for more than 3 years, HIV-RNA less than 50 copies/ml for more than 2 years and CD4 cell count more than 350 cells/ml. Factors associated with low (<150) or high (>1000), compared with intermediate (150–1000 copies/106 PBMC) levels of HIV-DNA were investigated using multinomial logistic regression.

522 patients who initiated ART during the chronic phase were included (71% male; median peak HIV-RNA: 4.88 log 10 copies/ml, CD4 cell count nadir: 222 cells/ml). Median ART duration was 13 years [interquartile range (IQR) 7–17], viral suppression was 5.7 years (IQR 3.9–8.5) and 66% of the patients never experienced ART failure. Median HIV-DNA was 323 copies/106 PBMCs (IQR, 129–717) with low, intermediate and high levels observed in 28.3, 55.4 and 16.3%, respectively. In multivariable analysis, women were more likely to achieve a low level of HIV-DNA. Each additional year with suppressed HIV-RNA increased the likelihood of low level and decreased the likelihood of high level of HIV-DNA. Peak HIV-RNA higher than 5 log10 c/ml was always associated with a decreased risk of low and an increased risk of high HIV-DNA. For patients with peak HIV-RNA lower than 5 log10 c/ml, past ART failure was associated with high level of HIV-DNA.

After a median duration of 13 years of ART, HIV-DNA level was still associated with peak viral load, and low level of HIV-DNA was more likely to be observed with longer duration of suppressed viremia. Avoiding any rebound in viral load while on ART is paramount.

In conclusion, chronically HIV-infected patients with long-term suppressive ART can achieve low total HIV-DNA but one over six still presented HIV-DNA above 1000 copies/106 PBMCs despite long-term viral suppression.