Objective: The objective of this study is to study factors associated with HIV-DNA levels in chronically infected patients on long-term suppressive antiretroviral therapy (ART).
Design: 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/μl.
Method: Factors associated with low (<150) or high (>1000), compared with intermediate (150–1000 copies/106 PBMCs) levels of HIV-DNA were investigated using multinomial logistic regression.
Results: Five hundred and twenty-two patients who initiated ART during the chronic phase were included (71% male; median peak HIV-RNA: 4.88 log10 copies/ml, CD4+ cell count nadir: 222 cells/μl). 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 5log10 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 5log10, past ART failure was associated with high level of HIV-DNA.
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.
aRegional Center for HIV Care and Coordination, INSERM UMR1027, Toulouse 3 University, Toulouse
bInfectious Diseases Dpt, CHU Archet, Nice
cINSERM, U1043, Centre de Physiopathologie de Toulouse Purpan
dCHU Toulouse, Hôpital Purpan, Virology Department, National Reference Center for Hepatitis E, Institut fédératif de biologie de Purpan, Toulouse
eInfectious Diseases Department, CHU Hotel Dieu, Nantes
fAPHP, Department of Therapeutics in Infectious Diseases, Hotel Dieu Hospital
gParis Descartes University, EA 7327, Sorbonne Paris Cité, Paris
hVirology Department, CHU Nice, Nice
iVirology Department, CHU Nantes, Nantes
jVirology Department, AP-HP, Hôpital Saint Louis, INSERM U941, Paris Diderot University, Paris
kVirology Department, CHU Strasbourg, Strasbourg
lSorbonne University, UPMC Univ. Paris 06-UMR_S 1136 Pierre Louis Institute of Epidemiology and Public Health
mINSERM-UMR_S 1136 Pierre Louis Institute of Epidemiology and Public Health
nAP-HP, Groupe hospitalier Pitié Salpêtrière, Laboratoire de Virologie, Paris
oVirology laboratory, University Hospital of Martinique, Fort-de-France
pINSERM, IAME, UMR 1137
qUniv Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité
rAP-HP, Hôpital Bichat-Claude Bernard, Virology Department, Paris
sVirology Department, CHU Lille, Lille
tCHU Clermont Ferrand, Laboratoire de Virologie, Hôpital Gabriel Montpied, Clermont-Ferrand
uSorbonne Universities, UPMC Univ. Paris 06, INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France.
*Dat’AIDS Study Group members are listed in the Acknowledgements.
Correspondence to Lise Cuzin, COREVIH - Batiment Turiaf - Hopital Purpan - TSA40031, 31059 Toulouse cedex, France. E-mail: firstname.lastname@example.org
Received 4 February, 2015
Revised 8 April, 2015
Accepted 13 April, 2015