Virological remission after antiretroviral therapyinterruption in female African HIV seroconvertersMorgane Gosseza, Genevieve Elizabeth Martina, Matthew Pacea,Gita Ramjeeb, Anamika Premrajb, Pontiano Kaleebuc, Helen Reesd,Jamie Inshawe , Wolfgang Stâ¬ohr e, Jodi Meyerowitza, Emily Hopkinsa,Mathew Jonesa , Jacob Hursta , Kholoud Porterf , Abdel Babikere ,Sarah Fidlerg, John Frater a,h,i , on behalfof the SPARTAC Trial InvestigatorsIntroduction: There are few data on the frequency of virological remission in Africanindividuals after treatment with antiretroviral therapy (ART) in primary HIV infection (PHI).Methods: We studied participants (n ¼ 82) from South Africa and Uganda in Short PulseAntiretroviral Treatment at HIV-1 Seroconversion, the first trial of treatment interruption inAfrican individuals with PHI randomized to deferred ART or 48 weeks of immediate ART.All were female and infected with non-B HIV subtypes, mainly C. We measured HIV DNAin CD4þ T cells, CD4þ cell count, plasma viral load (pVL), cell-associated HIV RNA andT-cell activation and exhaustion. We explored associations with clinical progression andtime to pVL rebound after treatment interruption (n ¼ 22). Data were compared with non-African Short Pulse Antiretroviral Treatment at HIV-1 Seroconversion participants.Results: Pretherapy pVL and integrated HIV DNA were lower in Africans comparedwith non-Africans (median 4.16 vs. 4.72 log 10 copies/ml and 3.07 vs. 3.61 log10 copies/million CD4þ T cells, respectively; P < 0.001). Pre-ART HIV DNA in Africans wasassociated with clinical progression (P ¼ 0.001, HR per log 10 copies/million CD4þ Tcells increase (95% CI) 5.38 (1.95â14.79)) and time to pVL rebound (P ¼ 0.034, HR perlog10 copies/ml increase 4.33 (1.12â16.84)). After treatment interruption, Africansexperienced longer duration of viral remission than non-Africans (P < 0.001; HR3.90 (1.75â8.71). Five of 22 African participants (22.7%) maintained VL less than400 copies/ml over a median of 188 weeks following treatment interruption.Conclusion: We find evidence of greater probability of virological remission followingtreatment interruption among African participants, although we are unable to differen-tiate between sex, ethnicity and viral subtype. The finding warrants further investiga-tion. Copyright à 2018 The Author(s). Published by Wolters Kluwer Health, Inc.AIDS 2019, 33:185â197Keywords: Africa, antiretroviral therapy, HIV, posttreatment control, remission,treatment interruption
