title: Virological Blips and Predictors of Post Treatment Viral Control After Stopping ART Started in Primary HIV Infection.
abstract: BACKGROUND
  Few individuals commencing antiretroviral therapy (ART) in primary HIV infection (PHI) maintain undetectable viremia after treatment cessation. Associated factors remain unclear given the importance of the phenomenon to cure research.
  
  
  METHODS
  Using CASCADE data of seroconverters starting ART in PHI (≤6 months from seroconversion), we estimated proportions experiencing viral blips (>400 copies followed by <400 copies HIV-RNA/mL without alteration of regimen) while on ART. We used Cox models to examine the association between time from ART stop to loss of control (2 consecutive measurements >1000 copies per milliliter) and magnitude and frequency of blips while on ART, time from seroconversion to ART, time on ART, adjusting for mean number of HIV-RNA measurements/year while on ART, and other confounders.
  
  
  RESULTS
  Seven hundred seventy-eight seroconverters started ART in PHI with ≥3 HIV-RNA measurements. Median interquartile range (IQR) ART duration was 16.2 (8.0-35.9) months, within which we observed 13% with ≥1 blip. Of 228 who stopped ART, 119 rebounded; time to loss of control was associated with longer interval between seroconversion and ART initiation [hazard ratio (HR) = 1.16 per month; 1.04, 1.28], and blips while on ART (HR = 1.71 per blip; 95% confidence interval = 0.94 to 3.10). Longer time on ART (HR = 0.84 per additional month; 0.76, 0.92) was associated with lower risk of losing control. Of 228 stopping ART, 22 (10%) maintained post treatment control (PTC), ie, HIV-RNA <50 copies per milliliter ≥24 months after ART cessation.
  
  
  CONCLUSIONS
  HIV viral blips on therapy are associated with subsequent viral rebound on stopping ART among individuals treated in PHI. Longer duration on ART is associated with a greater chance of PTC.
authors.affiliation: *Department of Genitourinary Medicine and Infectious Disease, Imperial College, London, United Kingdom; †University College London, London, United Kingdom; ‡Medical Research Council Clinical Trials Unit at University College London, London, UK. Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland; §Guys and St Thomas Hospital NHS Trust, London, United Kingdom; ‖Clinical and Epidemiological Sciences, FHI 360, Durham, NC; ¶Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; and #Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, Oxford University, United Kingdom; Oxford Martin School, Oxford, United Kingdom; Oxford NIHR Biomedical Research Centre, Oxford, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: Fidler
authors.forename: Ashley D
authors.initials: AD
authors.lastname: Olson
authors.forename: Heiner C
authors.initials: HC
authors.lastname: Bucher
authors.forename: Julie
authors.initials: J
authors.lastname: Fox
authors.forename: John
authors.initials: J
authors.lastname: Thornhill
authors.forename: Charles
authors.initials: C
authors.lastname: Morrison
authors.forename: Roberto
authors.initials: R
authors.lastname: Muga
authors.forename: Andrew
authors.initials: A
authors.lastname: Phillips
authors.forename: John
authors.initials: J
authors.lastname: Frater
authors.forename: Kholoud
authors.initials: K
authors.lastname: Porter
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D005260:Female; D006678:HIV / Q000302:isolation & purification*; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D006801:Humans; D008297:Male; D019562:Viral Load; D028761:Withholding Treatment
chemical_list: D044966:Anti-Retroviral Agents