Early ART Initiation May Delay HIV Viral Rebound After Treatment Interruption

The initiation of ART in the acute or early vs the chronic phase of HIV infection may positively affect time to viral rebound following treatment interruption.

Results of a systematic review and meta-analysis published in International Society for Infectious Diseases suggest HIV viral rebound after treatment interruption may be delayed by initiating antiretroviral therapy (ART) in the acute or early phase of HIV infection.

Investigators from Beijing Youan Hospital in China searched publication databases through July 2022 for studies that evaluated factors associated with the maintenance of viral suppression after discontinuing ART in the setting of HIV. A total of 31 studies were included in this analysis. The studies were published between 2011 and 2022, and 10 were of randomized controlled designs. Pooled estimates of the percentage of patients who maintained viral suppression beyond 12 weeks were determined using a fixed-effects model.

Overall, the median time to HIV viral rebound after treatment interruption was 3 (range, 1-8.68) weeks. At approximately 1 year, the median rate of post-treatment control was 8.1% (range, 3.2%-15.3%).

In a meta-analysis performed among only studies that assessed the use of an ART-only medication regimen (n=18), the time to viral rebound was more than 12 weeks in 5.1% (95% CI, 3.5%-7.6%; I2, 0%) of the included studies.

Stratified by ART initiation date, the percentage of patients who maintained control after treatment interruption for more than 12 weeks was significantly higher (P =.01) for those who initiated ART in the acute or early phases of HIV infection (8.7%; 95% CI, 5.5%-13.5%) compared with those who initiated ART in the chronic phase (2.7%; 95% CI, 1.2%-5.8%).

Stratified by CD4+ T-cell count prior to treatment interruption, patients who had a median CD4+ count at or above 800 cells/µL were significantly more likely (P =.23) to maintain viral suppression beyond 12 weeks (6.0%; 95% CI, 3.7%-9.6%) compared with those with a count of less than 800 cells/µL (3.3%; 95% CI, 1.3%-8.5%).

There were no significant associations observed between the rate of post-treatment control and median pre-ART viral load (P =.96), age (P =.96), median pre-ART CD4+ T-cell count (P =.71), median pre-ART nadir CD4+ T-cell count (P =.65), median ART duration (P =.48), and patient sex (P =.19).

Limitations were the small number of included studies and the inability to identify factors associated with increases in post-treatment control rates.

According to the investigators, “These findings provide clues to achieving long-term viral control without ART.”

References:

Zhou C, Wu Y, Zhang Y, et al. Factors associated with post-treatment control of viral load in HIV-infected patients: a systematic review and meta-analysis. Int J Infect Dis. Published online January 24, 2023. doi:10.1016/j.ijid.2023.01.025