HIV Time to Viral Rebound After Interruption of Modern ART. (ACTG) A5345

[Jim Allen]

Nothing we didn't already know, but I must have missed this article earlier this year so posting now.

In Full: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8906742/

In Brief:

Time to Viral Rebound After Interruption of Modern Antiretroviral Therapies

Participants underwent carefully monitored antiretroviral interruption. ART was restarted upon 2 successive viral loads ≥1000 copies/mL.

Thirty-three chronic-treated and 12 early-treated participants interrupted ART with evaluable time to viral rebound. Median time to viral rebound ≥1000 HIV RNA copies/mL was 22 days.

Acute retroviral rebound syndrome was diagnosed in 9% of the chronic-treated and none of the early-treated individuals.

In a combined analysis, a higher percentage of early-treated participants remained off ART at posttreatment interruption week 12 (chronic vs early: 2% vs 9%, P = .0496). One chronic-treated and one early-treated A5345 participant remained off ART for >24 weeks. All participants resuppressed after ART reinitiation.

Conclusions: Early ART initiation, using either older or newer ART regimens, was associated with a significant delay in the time to HIV rebound after ART interruption, lowering the barrier for HIV remission.

Li JZ, Aga E, Bosch RJ, Pilkinton M, Kroon E, MacLaren L, Keefer M, Fox L, Barr L, Acosta E, Ananworanich J, Coombs R, Mellors JW, Landay AL, Macatangay B, Deeks S, Gandhi RT, Smith DM. Time to Viral Rebound After Interruption of Modern Antiretroviral Therapies. Clin Infect Dis. 2022 Mar 9;74(5):865-870. doi: 10.1093/cid/ciab541. PMID: 34117753; PMCID: PMC8906742.

[Jim Allen]

Early ART usage and a longer delay of 12+ weeks in vial rebound makes some sense, given they would have a smaller viral reservoir.  We have all seen exceptions in adults who can even go 5-6 months before the viral rebound, not to mention a few kids who went years without a rebound.