Virological remission after antiretroviral therapy interruption in female African HIV seroconverters

Introduction There are few data on the frequency of virological remission in African individuals after treatment with antiretroviral therapy (ART) in primary HIV infection (PHI). Methods We studied participants (n=82) from South Africa and Uganda in SPARTAC, the first trial of treatment interruption (TI) in African 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 DNA in CD4 T cells, CD4 count, plasma viral load (pVL), cell-associated HIV RNA and T cell activation and exhaustion. We explored associations with clinical progression and time to pVL rebound after TI (n=22). Data were compared with non-African SPARTAC participants. Results Pre-therapy pVL and integrated HIV DNA were lower in Africans compared with non-Africans (median 4.16 vs 4.72 log10 copies/ml and 3.07 vs 3.61 log10 copies/million CD4 T-cells respectively; p<0.001). Pre-ART HIV DNA in Africans was associated with clinical progression (p=0.001, HR per log10 copies/million CD4 T cells increase (95% CI) 5.38 (1.95-14.79)) and time to pVL rebound (p=0.034, HR per log10 copies/ml increase 4.33 (1.12-16.84)). After TI, Africans experienced longer duration of viral remission than non-Africans (p<0.001; HR 3.90 (1.75-8.71). Five of 22 African participants (22.7%) maintained VL<400 copies/ml over a median of 188 weeks following TI. Conclusion We find evidence of greater probability of virological remission following TI among African participants, although we are unable to differentiate between sex, ethnicity and viral subtype. The finding warrants further investigation