Background There is interest in whether a short course of combination antiretroviral therapy (cART) at the time of human immunodeficiency virus (HIV) seroconversion could induce long-term immunologic control after its interruption. We aimed to determine the time of virologic rebound after interruption of treatment initiated close to HIV seroconversion and to identify potential cases of posttreatment controllers (PTCs) in the CASCADE (Concerted Action on Seroconversion to AIDS and Death in Europe) Collaboration.
Methods Prospective cohort study nested within the CASCADE database of routinely collected data about patients with HIV with well-estimated date of HIV seroconversion from Europe, Canada, and Australia in the post-cART era. Participants were individuals who interrupted successful cART initiated within 3 months of HIV seroconversion. The main outcome was loss of PTC status, defined as the earlier date of virologic rebound (first of 2 consecutive measurements showing HIV RNA levels >50 copies/mL) or reinitiation of any ART after cART interruption.
Results Median time to loss of PTC status in 259 eligible individuals was 1.7 months. Eleven patients did not experience virologic rebound by 24 months after treatment interruption.
Conclusion Most patients experience virologic rebound soon after cART interruption; however, although PTCs are rare, the results of this study confirm their existence.
Figure. Kaplan-Meier estimate of the proportion of patients maintaining virologic control after interruption of short-course cART initiated within 3 months of HIV seroconversion. Loss of virologic control is defined as experiencing at least 2 consecutive HIV RNA levels of more than 50 copies/mL or reinitiation of cART. cART indicates combined antiretroviral therapy; and HIV, human immunodeficiency virus.
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