Antiretroviral therapy (ART) has transformed HIV from a deadly disease into a lifelong infection that can be controlled. Nevertheless, in the majority of people living with HIV (PWH), discontinuation of ART results in viral rebound due to a latent proviral reservoir. Rarely, individuals known as post-treatment controllers (PTC) demonstrate prolonged viral control even after ceasing ART. Investigating the underlying mechanisms driving this sustained viral control has been a goal for the HIV research community. However, previous studies have been hindered by the scarcity of PTC cases, thereby restricting the potential for associative and translational research. Consequently, the aim of this study is to collect and meta-analyse the data from prior trials where PTC have been identified, as well as to retrospectively identify PTC from the routine care outside trials in a multicentre, multinational study called EU2Control. The aggregated clinical data, and the already collected material from trials where PWH consented for use in additional studies on HIV, will be analyzed with the goal to identify predictive biomarkers for sustained viral control. This study will be part of the research line on HIV cure from an ongoing collaborative consortium (EU2Cure). The first phase of this research line involves a retrospective cohort for meta-analysis and establishment of a biobank.
PTC: Viremic people living with HIV (HIV-RNA >1000c/mL) before ART initiation. Plasma HIV-RNA off ART ≤400c/mL at least 2 times at ≥24weeks apart and at ≥2/3rds of HIV-RNA measurements. Elite PTC with ≤50c/mL will be identified.
Post intervention controller (PIC): People living with HIV from ATI or MAP studies who meet the PTC criteria as per ATI/MAP study defined. Additional stratification occurs according to the duration of and level of suppressed plasma HIV-RNA (e.g. ≤400c/mL off ART at least 2 times for ≥8 weeks apart). This is done to streamline PIC definitions and capture PIC inMAP studies with an ART pause of less than 24 weeks.
Controls: non-controllers (NC) with plasma HIV-RNA >1000 c/mL after ART interruption.
Suppressors: viremic people living with HIV (HIV-RNA >1000c/mL) before ART initiation who became HIV-RNA <50c/mL suppressed on ART, remained on ART, and never had viral rebound.
1.Documented refusal of data use for research
People living with HIV meeting PTC inclusion criteria from previous ATI trials. In addition, PTC from routine care will be identified and included. Non controllers will be identified from ATI trials and routine care. To analyse the reservoir size, PTC (both from routine care and ATI trials) will be matched in a 1:1 ratio with non-controllers (NC). We will also match NC to a control group of people living with HIV who did not undergo an ATI (Suppressors). Matching will be performed on gender, age at the start of ATI (+/- 5 years, or age of first included sampling if no ATI performed), current CD4+ (+/- 25%, at the start of ATI or first included sampling if no ATI performed) and total years on ART if possible (+/-1 year, if \<5 years on ART. If \>5 years on ART: +/- 2 years), if possible. When matching on all criteria is impossible, in order of priority, matching will be done on total years on ART, gender, CD4 T-cell count, age.
Cohort
Retrospective
No Intervention: Observational Cohort
Other interventionNo intervention (observational cohort)
Intact proviral HIV DNA reservoir size in PTC and PIC before and during ATI
Reservoir size will be measured as intact proviral HIV DNA and reported as log copies per 10\^6 CD4+ cells. Reservoir size in PTC, PIC, and NC before and after ATI will be described according to data distribution.
Total integrated HIV DNA reservoir size in PTC and PIC before and during ATI
Reservoir size will be measured as total integrated HIV DNA and reported as log copies per 10\^6 PBMC. Reservoir size in PTC, PIC, and NC before and after ATI will be described according to data distribution.
Inducible HIV reservoir size in PTC and PIC before and during ATI
Reservoir size will be measured as inducible HIV and reported as log HIV RNA or HIV DNA copies. Reservoir size in PTC, PIC, and NC before and after ATI will be described according to data distribution.
Time from the start of ATI until first measurement of HIV RNA >50 copies/mL in PTC and PIC.
A survival analysis will be done for all PTC, PIC and NC who have been sourced from ATI trials. Baseline will be set as the start of the treatment interruption. Time will be noted in weeks until first measurement of HIV-RNA \>50 copies/mL for all study participants. Levels correspond to elite controller definition (Deeks \& Walker, 2007), PTC definition, and level below which HIV onward transmission rarely occurs (Gray et al., 2001). Analysis is by Kaplan Meier and Cox Proportional Hazard models with loss of viral control as event. Independent variables can be timing of ART initiation, duration of ART, HIV cure intervention (if any), demographic parameters (sex, age, place of birth, country of residence), viral dynamics (subtype, reservoir size) and immune characteristics (cd4+ count, cd8+ count, cd4/cd8 ratio).
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Erasmus Medical Center
Lead sponsor
EU2Cure consortium
Collaborator
Radboud University Medical Center
Collaborator
European Aids Treatment Group (EATG), Brussels, Belgium
Collaborator
University Hospital, Ghent
Collaborator
University Ghent
Collaborator
Oslo University Hospital
Collaborator
Charite University, Berlin, Germany
Collaborator
Institut Pasteur
Collaborator
University of Aarhus
Collaborator
IrsiCaixa
Collaborator
Fundació Lluita contra les Infeccions
Collaborator
IRCCS San Raffaele
Collaborator
Imperial College London
Collaborator
University of Oxford
Collaborator
Guy's and St Thomas' NHS Foundation Trust
Collaborator
Chelsea and Westminster Hospital, UK
Collaborator
Pomeranian Medical University Szczecin
Collaborator
Hospital Universitari Vall d'Hebron Research Institute
Collaborator
Medical University of Warsaw
Collaborator
Centre Hospitalier Universitaire Vaudois
Collaborator
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