HIV Clinical Trial
Official title:
Predictors of Time to Viremia With an Analytic Treatment Interruption
This is a two-center study of 30 HIV-infected participants who have been on antiretroviral
therapy (ART) for at least two years.
Participants will be asked to undergo LN and GALT biopsies both before and after a closely
monitored analytic treatment interruption (ATI).
The HIV field has made a dramatic shift to an emphasis on finding a cure for HIV.
However, there is no agreed upon test of cure, or even what the definition of a cure might
be. The investigator believes the most reliable test of cure will be an analytic treatment
interruption (ATI) with time to viremia as a standard measure of the impact of an
intervention on the degree to which the reservoir has been depleted. This is rational as
modeling studies utilizing ATI data point to reservoir size as an important predictor of time
to viremia(1) and other studies have shown that levels of HIV DNA(2) and cell associated HIV
RNA(3) prior to starting antiretroviral therapy (ART) are associated with time-to-rebound.
However, these studies used a limited sampling strategy to determine when viremia rebounded
and it is likely that greater sensitivity in measures of time-to rebound will be needed to
accurately assess the impact of an intervention. The investigators have tested an ATI
strategy where plasma HIV is sampled three times each week and ART is resumed once the virus
becomes detectable. In this small, pilot study, the investigators sampled lymph nodes, GALT,
plasma, and PBMC before, during, and after the ATI and found the time-to-rebound was 14 days
(range 5 to 30 days) and that total years of ART exposure was associated with the
time-to-rebound (4). The investigators propose a similar study that includes more intensive
blood and lymphoid tissue sampling to identify factors that predict time to-rebound to
provide a necessary foundation for future studies that utilize a treatment interruption as a
test of efficacy for curative interventions.
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