RT Journal Article
T1 Impact of CD4 and CD8 dynamics and viral rebounds on loss of virological control in HIV controllers.
A1 Chereau, Fanny
A1 Madec, Yoann
A1 Sabin, Caroline
A1 Obel, Niels
A1 Ruiz-Mateos, Ezequiel
A1 Chrysos, Georgios
A1 Fidler, Sarah
A1 Lehmann, Clara
A1 Zangerle, Robert
A1 Wittkop, Linda
A1 Reiss, Peter
A1 Hamouda, Osamah
A1 Estrada Perez, Vicente
A1 Leal, Manuel
A1 Mocroft, Amanda
A1 Garcia De Olalla, Patricia
A1 Ammassari, Adriana
A1 D'Arminio Monforte, Antonella
A1 Mussini, Cristina
A1 Segura, Ferran
A1 Castagna, Antonella
A1 Cavassini, Matthias
A1 Grabar, Sophie
A1 Morlat, Philippe
A1 De Wit, Stéphane
A1 Lambotte, Olivier
A1 Meyer, Laurence
A1 HIV Controllers Project Working Group for the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCOORD, 
AB 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.
YR 2017
FD 2017-04-05
LK http://hdl.handle.net/10668/11058
UL http://hdl.handle.net/10668/11058
LA en
DS RISalud
RD Apr 7, 2025