Impact of CD4 and CD8 dynamics and viral rebounds on loss of virological control in HIV controllers
Chereau, Fanny (Université Paris-Saclay)
Madec, Yoann (Institut Pasteur)
Sabin, Caroline A (Research Department of Infection and Population Health (Regne Unit))
Obel, Niels (Copenhagen University Hospital Rigshospitalet)
Ruiz-Mateos, Ezequiel (Instituto de Biomedicina de Sevilla)
Chrysos, Georgios (Tzaneio General Hospital of Piraeus)
Fidler, Sarah (Imperial College (Regne Unit))
Lehmann, Clara (University of Cologne and German Center for Infection Research)
Zangerle, Robert (DMedical University Innsbruck)
Wittkop, Linda (University Bordeaux)
Reiss, Peter (Stichting HIV Monitoring)
Hamouda, Osamah (Robert Koch Institute)
Estrada Perez, Vicente (Instituto de Investigación Sanitaria del Hospital Clínico San Carlos)
Leal, Manuel (Instituto de Biomedicina de Sevilla)
Mocroft, Amanda (Research Department of Infection and Population Health (Regne Unit))
García de Olalla, Patricia (Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública)
Ammassari, Adriana (Istituto Nazionale Malattie Infettive)
D'Arminio Monforte, Antonella (University Hospital (Itàlia))
Mussini, Cristina (University of Modena and Reggio Emilia)
Segura, Ferran (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Castagna, Antonella (San Raffaele Vita Salute University)
Cavassini, Matthias (Lausanne University Hospital)
Grabar, Sophie (Institut Pierre Louis d'Epidémiologie et de Santé Publique)
Morlat, Philippe (Université de Bordeaux)
De Wit, Stéphane (Université Libre de Bruxelles)
Lambotte, Olivier (Université Paris Sud)
Meyer, Laurence (Université Paris-Saclay)
Universitat Autònoma de Barcelona

Data:	2017
Resum:	HIV controllers (HICs) spontaneously maintain HIV viral replication at low level without antiretroviral therapy (ART), a small number of whom will eventually lose this ability to control HIV viremia. The objective was to identify factors associated with loss of virological control. HICs were identified in COHERE on the basis of ≥5 consecutive viral loads (VL) ≤500 copies/mL over ≥1 year whilst ART-naive, with the last VL ≤500 copies/mL measured ≥5 years after HIV diagnosis. Loss of virological control was defined as 2 consecutive VL >2000 copies/mL. Duration of HIV control was described using cumulative incidence method, considering loss of virological control, ART initiation and death during virological control as competing outcomes. Factors associated with loss of virological control were identified using Cox models. CD4 and CD8 dynamics were described using mixed-effect linear models. We identified 1067 HICs; 86 lost virological control, 293 initiated ART, and 13 died during virological control. Six years after confirmation of HIC status, the probability of losing virological control, initiating ART and dying were 13%, 37%, and 2%. Current lower CD4/CD8 ratio and a history of transient viral rebounds were associated with an increased risk of losing virological control. CD4 declined and CD8 increased before loss of virological control, and before viral rebounds. Expansion of CD8 and decline of CD4 during HIV control may result from repeated low-level viremia. Our findings suggest that in addition to superinfection, other mechanisms, such as low grade viral replication, can lead to loss of virological control in HICs.
Ajuts:	European Commission 260694
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada

DOI: 10.1371/journal.pone.0173893
PMID: 28380038

16 p, 1.2 MB

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