Levels Of Intracellular Hiv-Dna In Patients With Suppressive Antiretroviral Therapy

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/ml.Method: Factors associated with low (< 150) or high (> 1000), compared with intermediate (150-1000 copies/10(6) 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 log(10) copies/ml, CD4(+) cell count nadir: 222 cells/ml). 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/10(6) 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 5log(10) 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 5log(10), 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/10(6) PBMCs despite long-term viral suppression. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.