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  • Open Access

Pro-viral DNA and antiretroviral treatment simplification

  • 1,
  • 2 and
  • 2
Journal of the International AIDS Society201013 (Suppl 4) :P143

https://doi.org/10.1186/1758-2652-13-S4-P143

  • Published:

Keywords

  • Peripheral Blood Mononuclear Cell
  • Lamivudine
  • Zidovudine
  • Tenofovir
  • Nucleoside Analogue

The question of Highly Active Antiretroviral Treatment (HAART) simplification is important due to long term toxicity and cost of HAART.

Pro-viral HIV DNA associated with Peripheral Blood Mononuclear Cells (PBMC) is a marker of the HIV reservoir which is predictive of the evolution of HIV infection. It remains the only virological quantitative marker detectable during suppressive HAART. A pro-viral DNA > 2.7log before treatment interruption is predictive of a decline of CD4 T lymphocytes after interruption.

We measured PBMC's pro-viral DNA in patients treated with triple nucleoside analogue therapy containing zidovudine who had developed severe lipodystrophy and/or metabolic abnormalities. A switch to a nucleoside analogue bitherapy by stopping zidovudine was proposed for patients whose pro-viral DNA was < 2.7 log. We selected 11 patients (mean age 48 years, 5 women, mean duration of infection=10 years, mean CD4 nadir=288/mm3, mean plasma HIV RNA zenith =4,44 log). Patients were on triple nucleoside analogue therapy for 7 years with plasma HIV RNA< 40 copies/ml ; mean CD4 cells = 600/mm3. Mean pro-viral DNA was 2,43 log copies/million PBMC. Treatment was switched to abacavir+lamivudine in 5 patients and emtricitabine+tenofovir in 6.

After switch, with a mean follow up of 40 months, plasma HIV RNA remained< 40 copies/ml without blip and CD4 cells remained stable.

In conclusion, treatment simplification with an analogue nucleoside bitherapy is possible in a selected group of patients who were treated with a triple nucleoside analogue therapy in virological success and had a PBMC’s associated pro-viral DNA < 2.7 log before treatment simplification.

Avettand-Fenoel V, Boufassa F, Galimand J, Meyer L, Rouzioux C (2008) HIV-1 DNA for the measurement of the HIV reservoir is predictive of disease progression in seroconverters whatever the mode of result expression is. J Clin Virol 42: 399-404

Authors’ Affiliations

(1)
Foch Hospital, Internal Medicine, Suresnes, France
(2)
Université Paris-Descartes, CHU Necker-Enfants Malades, Virology Unit, Paris, France

Copyright

© Zucman et al; licensee BioMed Central Ltd. 2010

This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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