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Plasma HIV Viral Rebound following Protocol-Indicated Cessation of ART Commenced in Primary and Chronic HIV Infection
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OBJECTIVES: The magnitude of HIV viral rebound following ART cessation has consequences for clinical outcome and onward transmission. We compared plasma viral load (pVL) rebound after stopping ART initiated in primary (PHI) and chronic HIV infection (CHI). DESIGN: Two populations with protocol-indicated ART cessation from SPARTAC (PHI, n = 182) and SMART (CHI, n = 1450) trials. METHODS: Time for pVL to reach pre-ART levels after stopping ART was assessed in PHI using survival analysis. Differences in pVL between PHI and CHI populations 4 weeks after stopping ART were examined using linear and logistic regression. Differences in pVL slopes up to 48 weeks were examined using linear mixed models and viral burden was estimated through a time-averaged area-under-pVL curve. CHI participants were categorised by nadir CD4 at ART stop. RESULTS: Of 171 PHI participants, 71 (41.5%) rebounded to pre-ART pVL levels, at a median of 50 (95% CI 48-51) weeks after stopping ART. Four weeks after stopping treatment, although the proportion with pVL ≥ 400 copies/ml was similar (78% PHI versus 79% CHI), levels were 0.45 (95% CI 0.26-0.64) log(10) copies/ml lower for PHI versus CHI, and remained lower up to 48 weeks. Lower CD4 nadir in CHI was associated with higher pVL after ART stop. Rebound for CHI participants with CD4 nadir >500 cells/mm(3) was comparable to that experienced by PHI participants. CONCLUSIONS: Stopping ART initiated in PHI and CHI was associated with viral rebound to levels conferring increased transmission risk, although the level of rebound was significantly lower and sustained in PHI compared to CHI.
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Cessation of therapy in HIV is associated with a strong viral rebound to pre-therapeutic plasma viral loads.
“The cessation of therapy in HIV is associated with a strong viral rebound to pre-therapeutic plasma viral loads [164,165,166]”
From Current State of Therapeutics for HTLV-1 (2024) · cites this paper as [164]
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Barongo, A., & Kwesigabo, G. (2025) · doi:10.38124/ijisrt/25apr1931 · Cited by 1
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Hicks, C. B. (2012) · Journal watch · doi:10.1056/ac201210290000005
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Metadata
- Authors
- Hamlyn, E., Ewings, F. M., Porter, K., Cooper, D. A., Tambussi, G., Schechter, M., Pedersen, C., Okulicz, J. F., McClure, M., Babiker, A., Weber, J., Fidler, S., & on behalf of the INSIGHT SMART and SPARTAC Investigators
- Affiliations
- National Health Service (GB)
- Medical Research Council (GB)
- UNSW Sydney (AU)
- IRCCS Ospedale San Raffaele (IT)
- Universidade Federal do Rio de Janeiro (BR)
- Odense University Hospital (DK)
- Brooke Army Medical Center (US)
- Imperial College London (GB)
- Corresponding author
- Hamlyn, Elizabeth
- ORCID
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2012-08-31
- Volume
- 7
- Issue
- 8
- Pages
- e43754
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC3432055
- OpenAlex
- W2141943803
- Cited by
- 71
- References
- 27
- Citations by year
- 2025: 3 · 2024: 3 · 2023: 2 · 2022: 3 · 2021: 4 · 2020: 6 · 2019: 9 · 2018: 4 · 2017: 4 · 2016: 10 · 2015: 6 · 2014: 8 · 2013: 6 · 2012: 2
- FWCI
- 3.15
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Dipòsit Digital de la Universitat de Barcelona (Universitat de Barcelona) (publishedVersion, cc-by)
- University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Figshare (submittedVersion, cc-by)
- Sussex Research Online (University of Sussex) (submittedVersion, cc-by)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- UCL Discovery (University College London) (submittedVersion)
- Spiral (Imperial College London) (submittedVersion, other-oa)
- Funders
- University of Pittsburgh
- Wellcome Trust (WT069598MA, 069598)
- National Institute for Health and Care Research (NF-SI-0507-10313)
- Imperial College London
- University of Oxford
- University of New South Wales
- Universidade Federal do Rio de Janeiro
- Medical Research Council
- National Institute of Allergy and Infectious Diseases (U01AI068641, U01AI046362, U01AI042170, R01AI046995)
- Topics
- Life Sciences › Immunology and Microbiology › Virology › HIV Research and Treatment
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS drug development and treatment
- Keywords
- primary HIV infection, chronic HIV infection, plasma viral load, CD4 nadir, HIV risk factors, SMART trial
- MeSH terms
- Adult, Chronic Disease, Female, HIV, Humans, Male, Middle Aged, HIV Infections, CD4 Lymphocyte Count, Anti-HIV Agents, Viral Load, Withholding Treatment
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