A5321: Decay of HIV-1 Reservoirs in Patients on Long-Term Antiretroviral Therapy A5321: Decay of HIV-1 Reservoirs in Patients on Long-Term Antiretroviral Therapy: The ACTG HIV Reservoirs Cohort (AHRC) Study

Study Location:

Washington

Topic:

Clinicaltrials.gov Link:

https://actgnetwork.org/clinical-trials/recent-study-results

Coordinator:

Anna Wimpelberg

Enrollment:

Closed

Trial Period:

Ongoing

The study is being done to try to determine which factors contribute to the persistence of HIV (how long the virus remains) in your body over time when you are taking anti-HIV medications.  The team believed that the following may be important:

  • viral load (the amount of HIV in your blood),
  • CD4 cell count (a measure of your body’s ability to fight infection),
  • when you started taking anti-HIV medications (in relation to when you were first infected),
  • genetics (features [or traits] that you were born with),
  • the amounts of your anti-HIV medications that are in your body.

The team wanted to understand whether the level of HIV in the blood is related to activity of your immune system (your body’s infection-fighting system). We know from previous work that markers of immune activity that indicate ongoing inflammation in the blood are higher in people with HIV than in people who do not have HIV.  This is true even when the HIV is well controlled with medications.

In this study, it was found that people who had higher levels of inflammation and HIV before starting anti-HIV medications tended to have higher levels of inflammation and HIV using special blood tests long after they started taking anti-HIV medications, and even when they had undetectable viral loads on regular blood tests.  This is what we mean when we say “the die is cast”, e.g. what happens before starting treatment, how your body reacts to HIV before starting to take the medicines is the most important factor determining the amount of HIV left in your body when you take the medicines.  This information tells us that we need to find ways to protect the immune system as early as possible after HIV infection and limit the inflammation that develops. One way to do this would be to start anti-HIV medications as soon as possible after HIV infection.

The results we have so far also suggest we need new treatments to reduce inflammation in people with HIV, even if they have undetectable viral loads. The ACTG is studying a number of potential ways to reduce this inflammation. We hope that these future treatments will also improve health in people living with HIV. You may be interested in asking about those studies to your research nurse.

Anna Wimpelberg: awimpelberg@whitman-walker.org

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