title: Total cellular HIV-1 DNA decreases after switching to raltegravir-based regimens in patients with suppressed HIV-1 RNA.
abstract: The integrase inhibitor raltegravir has been used to intensify antiretroviral therapy in patients with undetectable plasma HIV-1RNA, resulting in variable perturbation of HIV-1 nucleic acids levels in peripheral blood.
  
  
  
  We aimed at monitoring residual plasma HIV-1RNA and total cellular HIV-1DNA in virologically suppressed patients switching to raltegravir-based regimens.
  
  
  
  Fifty-eight subjects on protease inhibitor (PI) or nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens, with plasma HIV-1RNA levels <40 copies/ml for ≥6 months and CD4 counts >200cells/μl for ≥12 months were enrolled. Thirty-four patients were from the treatment simplification RASTA randomized study switching standard therapy to a raltegravir-based regimen (RASTA group), while 24 continued a PI or NNRTI based-regimen (controls). Residual plasma HIV-1RNA (5-40copies/mL) and HIV-1DNA were assessed at 0, 24 and 48 weeks.
  
  
  
  At week 0 (W0), HIV-1DNA was detected in all patients while at W48 it was detectable in 82.4% of the RASTA group vs 100% of controls (p=0.03). There was a significant decline of HIV-1DNA at W48 in the RASTA group (mean change from baseline -0.21 [95% CI -0.41; -0.01] log10copies/106CD4; p=0.03) but not in controls. Ultrasensitive HIV-1RNA was detectable at baseline in 50% of RASTA group vs 67% of controls and at W48 in 32.4% vs 42%, respectively. No differences were found between HIV-1RNA levels at baseline and W48 within and between groups.
  
  
  
  Switching successful therapy to raltegravir-based regimens may be associated with a decrease of the HIV-1 reservoir, as measured by peripheral blood cellular HIV-1DNA levels.
authors.affiliation: Infectious Diseases Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy; Clinic of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy. Electronic address: brossetti1982@gmail.com.
authors.forename: Barbara
authors.initials: B
authors.lastname: Rossetti
authors.affiliation: Medical Biotechnology Department, University of Siena, Siena, Italy.
authors.forename: Genny
authors.initials: G
authors.lastname: Meini
authors.affiliation: Infectious Diseases Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Bianco
authors.affiliation: Clinic of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Lamonica
authors.affiliation: Clinic of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Mondi
authors.affiliation: Clinic of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Belmonti
authors.affiliation: Clinic of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Iuri
authors.initials: I
authors.lastname: Fanti
authors.affiliation: Clinic of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Ciccarelli
authors.affiliation: Clinic of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Di Giambenedetto
authors.affiliation: Medical Biotechnology Department, University of Siena, Siena, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Zazzi
authors.affiliation: Infectious Diseases Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy; Clinic of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy; Medical Biotechnology Department, University of Siena, Siena, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: De Luca
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D004279:DNA, Viral / Q000097:blood*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000821:virology; D019428:HIV Integrase Inhibitors / Q000627:therapeutic use; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D007963:Leukocytes, Mononuclear / Q000821:virology; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood*; D000068898:Raltegravir Potassium / Q000008:administration & dosage / Q000627:therapeutic use*; D019562:Viral Load / Q000187:drug effects
chemical_list: D019380:Anti-HIV Agents; D004279:DNA, Viral; D019428:HIV Integrase Inhibitors; D012367:RNA, Viral; D000068898:Raltegravir Potassium
keywords: HIV-1 DNA; HIV-1 reservoir; Integrase inhibitors; Raltegravir; Ultrasensitive HIV-1 RNA