Baseline Cellular HIV DNA Load Predicts HIV DNA Decline and Residual HIV Plasma Levels during Effective Antiretroviral Therapy

Abstract

Cellular human immunodeficiency virus type 1 (HIV-1) DNA may be considered a marker of disease progression with significant predictive power, but published data on its correlation with plasma HIV RNA levels and CD4 counts in acute and chronic patients are not conclusive. We evaluated a cohort of 180 patients naïve for antiretroviral therapy before the beginning of treatment and after a virological response in order to define the indicators correlated with HIV DNA load decrease until undetectability. The following variables were evaluated as continuous variables: age, CD4 cell count and log 10 HIV DNA level at baseline and follow-up, and baseline log 10 HIV RNA level. Primary HIV infection at the start of therapy, an HIV RNA level at follow-up of <2.5 copies/ml, origin, gender, and transmission risk were evaluated as binary variables. The decline of HIV DNA values during effective therapy was directly related to baseline HIV DNA and HIV RNA values, to an increase in the number of CD4 cells, and to the achievement of an HIV RNA load of <2.5 copies/ml. An undetectable cellular HIV DNA load was achieved by 21.6% of patients at the follow-up time point and correlated significantly with lower baseline cellular HIV DNA values and with being in the primary stage of infection when therapy started. In conclusion, early treatment facilitated the achievement of undetectable levels of plasma viremia and cellular HIV DNA and a better recovery of CD4 lymphocytes. HIV DNA levels before and during highly active antiretroviral therapy may be used as a new tool for monitoring treatment efficacy.

Total HIV-1 DNA, a Marker of Viral Reservoir Dynamics with Clinical Implications

“…This was confirmed by Parisi et al, who showed that baseline HIV DNA load predicted the residual HIV RNA plasma level during effective cART (107).…”

“…The lowest HIV DNA levels were observed in patients who had low baseline levels and who received early treatment (107). In children, the HIV DNA level was markedly lower when viral control was achieved before age 1 year than between the ages of 1 and 5 years or after age 5 years (73).…”

“…This decline varies among patients. It correlates directly with pretherapeutic HIV DNA levels (97,102) and HIV RNA levels (97), as well as with the baseline CD4 cell count (102), the CD4 cell increment (97,100), and the chance of achieving HIV RNA loads of Ͻ2.5 copies/ml (107). Pretherapeutic HIV RNA load was also predictive of the decline in HIV DNA load in children, independently of pretherapeutic HIV DNA load (110).…”

“…The decline in total blood HIV DNA in patients adherent to cART has been extensively studied in both adults and children (57,77,78,82,(95)(96)(97)(98)(99)(100)(101)(102)(103)(104)(105)(106)(107)(108)(109). This decline varies among patients.…”

Strong and persistent correlation between baseline and follow-up HIV-DNA levels and residual viremia in a population of naïve patients with more than 4 years of effective antiretroviral therapy

“…A few data concerning long-term human immunodeficiency virus (HIV)-DNA monitoring have been reported [1][2][3][4][5][6][7] and it is not known how the demonstrated correlations between HIV-DNA levels and the main viro-immunological parameters could change over the course of effective treatment. The purpose of our study was to determine correlations between baseline HIV-RNA, cellular HIV-DNA, undetectable residual viremia (URV, <2.5 copies/mL), CD4 count, and acute or chronic infection at the start of antiretroviral therapy (ART) in naïve patients who responded to ART.…”