Early antiretroviral treatment (ART) limits proviral reservoirs, a goal for HIV-1 remission strategies. Whether this is an immediate or long-term effect of virologic suppression (VS) in perinatal infection is unknown.
We quantified HIV-1 DNA longitudinally for up to 14 years in peripheral blood mononuclear cells (PBMCs) among 61 perinatally HIV-1-infected youth in the Pediatric HIV/AIDS Cohort Study who achieved VS at different ages. Group 1 (N=13) were < 1 year of age and group 2 (N=48) were between 1-5 years of age at VS. Piecewise linear mixed effects regression models assessed the effect of age at VS on HIV-1 DNA trajectories during VS.
In the first 2 years following VS, HIV-1 DNA levels decreased by -0.25 (95% CI: -0.36, -0.13) log10 copies/million PBMCs per year and was faster with early VS by age 1 year compared with after age 1 (-0.50 and -0.15 log10 copies/million PBMCs per year, respectively). Between years 2 and 14 from VS, HIV-1 DNA decayed by -0.05 (95% CI: -0.06, -0.03) log10 copies/million PBMCs per year and was no longer significantly different between groups. The estimated mean half-life of HIV-1 DNA from VS was 15.9 years and was shorter for group 1 compared to group 2 at 5.9 years and 18.8 years, respectively (p=0.09). Adjusting for CD4 cell counts had no effect on decay estimates.
Early effective, long-term ART initiated from infancy leads to decay of HIV-1-infected cells to exceedingly low concentrations desired for HIV-1 remission strategies.
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